Yesterday we opened up about how diabetes can bring us down. Today let’s share what gets us through a hard day. Or more specifically, a hard diabetes day. Is there something positive you tell yourself? Are there mantras that you fall back on to get you through? Is there something specific you do when your mood needs a boost? Maybe we’ve done that and we can help others do it too? (Thanks to Meri of Our Diabetic Life for suggesting this topic.)
There are several common phrases that you will hear in the diabetes community, specifically in relation to blood glucose readings and not placing a values judgment on them. Some of my favorites are “Check and correct.” and “It’s just data” – both in reference to numbers that fall outside of the sometimes very narrow and hard to hit target of “in range” especially when you are attempting to control the glucose levels of a child who sometimes (usually) has their own agenda when it comes to food, activity, stress, etc.
It can be stressful to see numbers that are consistently out of range since the target range is not there to mock us, but to minimize the change of developing either immediate health issues, as with low blood sugars, or complications that can come later in life from high blood sugar levels that can effect anything from the eyes, kidneys, heart, or the nerves to name a few. While today’s current technology and faster acting insulins can greatly help reduce those risks, they do still exist especially if you are not diligent about managing said numbers.
And of course, with raising a child with diabetes it is sometimes a tight rope walk of watching what you say and how you react to seeing numbers that fall outside of that small target. Children learn from watching us and don’t have the brain development and cognitive ability to determine whether mom panicking over a 350 blood sugar and asking if they ate anything is just concern or an accusation. Especially when such high (or low) blood sugars can cause mental fuzziness or other feelings of not feeling well to start with. It’s easy to see how a child could take a question like “Did you eat something and not tell me or bolus?” and interpret it as “You did something wrong.” and take it personally. I know I am guilty of often asking Angelina “Did you eat something and not bolus?” when I see high blood sugar readings. It almost always makes her defensive. But, the reason I ask is not to accuse her of something, but to start the process of determining the next step to take and worrying about how worried I should be about a 350 reading.
If it was in fact that she ate something and forgot to bolus then it’s probably fine to “check and correct” and put it out of my mind until the next time she’s due to check her blood sugar. But, if she didn’t eat anything, then a 350 blood sugar may be a signal of something else going on. It could be anything from an infusion site issue, bad insulin, impending illness, stress, growth hormone, etc. I would take further steps to investigate if no food was consumed such as checking the infusion site for any signs of an issue or perhaps changing out the insulin. I would also probably check for ketones to make sure that there is insulin in her system. If it was simply she ate some chips and didn’t give insulin then it’s not as urgent to check for ketones. It’s more a matter of determining what is wrong, rather than something that was done wrong by the child. But, those nuances are often hard for children to understand, even when you explain.
Another saying “It’s just data” ties into this as well. Those numbers are just data that indicate what the next step should be, if any need to be taken. It can be difficult to suppress the emotion that an unexpected reading may cause, but reminding myself (and Angelina) that it’s just data helps. But really, that’s all a blood glucose reading is: data. An in range number tells me when and how much to bolus if it’s meal or snack time. Below range numbers tell me we need to either watch and wait, or take action. Above range numbers tell me the same, depending on when they occur. Fortunately Angelina’s dexcom does help us avoid some surprises and attempt to take action before it gets to a critical level, but not always. We recently have had a few times where the Dexcom was reporting in range numbers, but Angelina was acting strangely so a fingerstick was taken only to discover that her actual number was dangerously low despite the rosy picture painted by her CGM. These instances are few and far between, but they do happen.
It can be hard to suppress that urge to wonder out loud “what happened?” when the result is unexpected. I certainly didn’t expect to see a 34 mg/dL reading on her meter a few weeks ago when she decided to take a nap in the middle of a Sunday afternoon. But then a diabetes-trained brain kicks in and says “Okay, what’s the next step?” in this case it was trying to wake her to drink some juice. It just goes to show that diabetes is unpredictable and sometimes the nuance can be more telling than the data. It’s important to look at all the data, not just the numbers. Odd or out of character behavior or emotions can be signs that something is going on, even if a number on the meter says things are peachy. It’s important to be tuned in to your or your child’s “signs”. It’s also important to remember that sometimes we/they are just people who experience emotions and odd behaviors that have nothing to do with diabetes, just like any one else.