Welcome?

If you have found this blog, saying Welcome does not really seem appropriate. I know you wish you weren't surfing the internet for diabetes. I felt the same.

A big part of me wishes I were not writing about diabetes, nor did I anticipate to become so opinionated or informed on the subject, but it happened. In 2010, my son was diagnosed with Type 1 Diabetes.

It wasn't really part of the plan… Correction - it was not part of the plan, but it happened. It is not always easy, but I think we are all doing okay, and I hope we continue to do so.

Why the Middle East? I happen to live in Dubai. I don't think that living in the Middle East makes mine or my son's diabetic experience any more unique or challenging than it does elsewhere in the developed world.

I hope you stick around, or read something you like. Feel free to comment and join the conversation, subscribe or follow this blog by liking the Facebook page Diapoint.

Please note: This blog does not give medical advice. I am opinionated, and I share my experiences, but the first rule of diabetes is to follow up with your doctor and/or nurse educator about your care, diagnosis or medication. If you do not have a medical practitioner that is helping you find your way through this crazy world, then do not give up until you find the right one.

Tuesday, June 24, 2014

Ramadan and Diabetes

Sheikh Zayed Grand Mosque, Abu Dhabi
As we approach Ramadan, there will be many people in this region fasting.  While I am not Muslim, I took a look through the internet to see if there was anything readily available for the general diabetic public on this subject.  I found more medical discussions than advice.

I am aware that people with severe medical conditions are exempt from fasting - this includes diabetics according to what I read. Fasting was not medically recommended for diabetics.  This is due to the high chance of hypoglycemia, which can be deadly.  I would expect the long days of summer would only increase the risks.

I suggest to read something like this document, or others out there to get more information before you meet with your doctor to discuss fasting.  The link I have posted was written by a physician in Egypt, so he understands the importance of Ramadan.

Please do not just read a few articles and try to go it alone.  It is important to go to your doctor that manages your diabetes with knowledge and questions.  As we know - especially in the case of Type 1, each body is different so may have different requirements.

As the article I posted suggests, also make sure your family, coworkers and others who will be near you throughout the day are all aware of your diabetes and aware of what to do should you need help.   We should all be doing this even when it is not Ramadan.

If you do decide that you want to try to fast, speak to your doctor about this before you start.  I would also assume some follow up throughout Ramadan would be necessary.

Ramadan Kareem.

Saturday, June 14, 2014

Surfing the Diabetic Wave

We got our quarterly hemoglobin A1c check up last week.  Another 7.2% for the third time in a row.  Our endocrinologist praises us and says we should be excited.  I am glad it is not higher, but yet, I still want better. We achieved a 6.8 once, so I know we can do better.

I am not some crazy perfectionist mom, but I am fighting a silent disease that if not well managed can effect my son's health as he gets older.  His eyes, feet, heart, or other organs.  As his primary caretaker, I am responsible to do that for him.

According to an article on Medscape about children not meeting the A1c targets, The ADA, (American Diabetes Association) recommends hemoglobin A1c targets of less than 8.5% for children under age 6, less than 8.0% for those age 6-12 years old, and less than 7.5% for those age 13 and up.  The International Society for Pediatric and Adolescent Diabetes (ISPAD) recommends a target of 7.5% or less for children of all ages (M. Tucker)

I will continue to strive for less than the ISAPD target, and less than 7%.  Normal hemoglobin in a non-diabetic person is between the range of 4-6%.  Doctors will tell you to be careful with managing it too tightly in a Type 1. A result closer to 6% could mean too many low blood sugar readings, or hypoglycemia which robs the body of the sugar it needs.  There is probably a very fine line between well managed blood sugar and over managing that in a Type 1.

While our endocrinologist thinks I am awesome, our pediatrician often lectures me on the importance of getting to 6%.  I do know the importance.  There may be parents that don't, but its frustrating when you know.  I think he is a good pediatrician, so I let him do his doctor thing.  I always strive to do it better, but the lecture of what I already know doesn't help.

You will probably find that many doctors have differing opinions about A1c.  Even international standards seem to not agree.  This goes back to one of my mantras of arming yourself with as much information as possible and making the best decisions with the doctor that you consider your primary diabetic source.  In this case, it is our pediatric endocrinologist.

So while I am told I should hold my head high at 7.2%, I am kind of defeated by my own goal.  I often compare diabetes to surfing.  There are A1c waves, and sometimes I surf quick, large monstrous blood sugar waves too. After last week's reading I am now paddling out to sea again to catch the big wave, ride it smoothly for as long as I can and hopefully not have a bad wipe out.

A windsurfing image seemed appropriate because with any luck, maybe the wind will carry me a bit too.




For more information about hemoglobin A1c, start here.

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Wednesday, June 11, 2014

School Lock Downs and Such

I saw a map on Facebook this morning that shows the location of every school shooting in the US  since the awful tragedy at Sandy Hook elementary.  A total of 74 school shootings!  And now this afternoon I read of a 75th!

What is going on?  I cannot believe the headlines.  It is so random.  It is so heartbreaking.

Before the Sandy Hook incident, there were other school shootings in the US.  None should be taken lightly. Even one is too many! These are tragedies that once you read about them, you can't unread it.

I am in another country with a very low crime rate, and no school shootings that I am aware of. The fact that schools can go on "lock down" made me weary as the mom of a Type 1 diabetic.  That means my son needs a snack box in every location he could be in throughout the day.

Last year my son had a homeroom, and he would go to PE, Library and Music in other rooms.  This year he had a few other activities to rotate through, which meant even more locations he could be in at any given time of hypoglycemia.  If there were a long lock down, that would be inevitable.

I felt kind of funny proposing "lock down boxes".  Was I over reacting?  Being too American?  The former risk manager side of me coming out?  Where to begin.  How could I say, "You know, in case there is a school shooting".  In Dubai, this is unheard of.

I gave myself the internal mom talk.  Who cares what other people think.  This is your child, and you are responsible for his well being.  They will think you are crazy for a million other reasons, so just add this one to this list.

I first approached this through the school health office by asking if there was a lock down policy.  I was honestly relieved to learn there was.  One, because well, that is just good, and two, I did not look like such an idiot asking about it. I did not need to mention any school shooting or any other unthinkable catastrophe that will not likely happen.  I then told them I wanted to meet with each teacher and place snack boxes in every room where he has classes and they were fine with that.

This ended up working out well because sometimes if the nurse comes down to the class to check him, instead of him going to the health office when he is low, they can treat it immediately without going all the way back to the health office.  I tell myself that this also has some psychological benefit because he hates to miss out on what his class is doing.  Even though he really doesn't miss anything, it helps him feel not so different.  The class supplies are replenished, and all is good.

Each of my snack boxes holds about 2-3 juice boxes and a few snack bars.  If your child can self manage and you have extra glucometers, then maybe you want to include those also.  As his teachers are not trained to use his pump, I am okay that boluses be dealt with by the nurses or myself after they are released.

About a week before school, I met with my son's new teacher and new principal with a nurse from the health office.  I provided them with general information about diabetes, as well as specifics to my son.  I will do the same next year, perhaps minus the principal.

This worked out really well.  I have a good relationship with the nurses and they also did additional education for all his teachers, and others who have diabetic children in their class.  I trust they were thorough. Everyone then knows what to expect, you have peace of mind, and you know that your child will be looked after if a situation were to occur.

So as we approach the last few days of school, why do I write about this now?  Well, its on my mind.  When is diabetes not on our minds?  When I read about something that effects children, the mom in me has to calculate how that would effect my son - both as a boy and a diabetic.

If you did not have supplies for a lock down at school this year, plan to have them ready to go on your child's first day of school for the fall.  We can't predict everything, but we can try to prepare them or in this case, their environment.

Maybe someday there will be a cure, and parents of diabetic kids will not have to worry about these extra boxes. Just as much, I wish for no school shootings.  Then no parent will have to think of these tragedies.  Ever.

Saturday, June 7, 2014

Pattern Management

When you are learning how to manage Type 1 diabetes, there are many subjects to be covered: carb to insulin ratios, how to treat low blood sugars, high blood sugar corrections, sick day management and so much more. If your healthcare team does not teach you about these, you need to find a team that is knowledgable and can teach you about these subjects. I also highly recommend the book How to Think Like a Pancreas.

A screen shot from my Up App.  
In addition to the crazy new world of blood sugar patterns, you will enter another dimension with your own sleeping pattern. Remember the revelation of how little sleep you needed after kids? If you are the caretaker of a Type 1, you will be even more amazed at how little sleep you can function on - especially the first year or so.

I promise, it will get easier.  I think I went a good two years without much sleep.  Everyone has a learning curve, or a certain level of comfort they can sleep with.  Don't judge yourself for not sleeping. You are normal.

Many people now use CGMs (Continuous Glucose Monitors) and that gives them a certain level of comfort.  There are some CGMs that "talk" to insulin pumps and suspend the pump when a low is approaching to avoid hypoglycemia.

I usually check my son's blood sugar before I sleep.  It gives me a feel for what to anticipate through the night.  If it is incredibly off, I will set an alarm to wake up again and check it after I treated it. Often I wake up in the middle of the night to check him just because I wake up to check it.  Don't' underestimate your instinct.

When managing sick days, I do not sleep much.  If I do, I am up almost every hour to check until the blood sugar is consistent.  You may be too worried to sleep, and that is okay too.

The picture here is a screen shot from my Up App.  My husband got me one of those cool healthy lifestyle mobile devices that tracks my movement and sleep.  It does encourage me to walk more, but there is no direct relationship to this and Type 1 caretaker sleeping patterns.

On this particular day, my son's pump insertion site was off causing some highs that needed to be managed throughout the night.  Blue indicates sleep, orange is awake.  It is a bit extreme, and not every day is like that, but there are times when it will feel like this.

Once you have the sick days behind you, take a rest if you can.

I've not had time to do this either, but it seems like good advice.  More importantly, the "bad" days will become fewer, and you will not want to miss out on the good ones.

Wednesday, June 4, 2014

There Will Be Questions

As a Type 1, or the caretaker of a Type 1, you will get a lot of questions about the disease.  In general, this is good as people are curious about health. They usually don't mean anything by it, but there will be times when you will really not feel like entertaining questions.  I think this is perfectly normal and healthy.  What to say on the days where you are frustrated by those questions - I still do not know.

You will most often be asked if a special diet is needed as the general population is most familiar with Type 2. Unfortunately, the management of Type 1 is not that easy as we are insulin dependent.  Meaning, the pancreas does not work.

I often use a carrot vs carrot cake analogy.  It doesn't matter.  A Type 1 still needs insulin for what they eat.  For sure, you need to have the proper carb to insulin ratios, and be aware of the other gazillion factors that can change things.   It is not always straight forward, but this is my quick way to give some perspective in non medical terms.

For every five times you are asked this question, you will get at least one off the wall question.  They are usually not meant to be hurtful, but sometimes I do take a deep breath before answering.

- What is in the pack?  Is that a cell phone?  I know this is Dubai, but he is only six!
- Does he still wear an oxygen mask?  No.  He never did.
- While it was not presented as a question, alarming all security staff at the entrance to a consulate that my child is wired with a device rather than just discretely wiping it down to check for explosives was a tough one.
- He will outgrow it, right?  Unfortunately, no.
- You must have eaten too many sweets when you were pregnant.  Forget the fact that I ate pretty healthy and exercised, but no, that doesn't cause Type 1 diabetes.
- Does it run in your family?  Genetics can play a factor.  There are families with more than one Type 1 child.  We do not have any Type 1 history in our family.
- Which one of you (me or my husband) is a carrier?
- What is that?  For his ears? (in regards to his insulin pump)
- We now happen to have a cat that is Type 2.  Someone asked me recently if this was related to my son's diabetes.  Diabetes is not transferable from animals to humans or vice versa - nor is it transferable from human to human.
- One of my son's sweet friends once asked if he kept carrots in his pump pack.  This was after he asked what it was, and the response was "This is my pump.  It keeps me healthy".
- A journalist from a local newspaper once asked me if I felt there needed to be more awareness about Type 1.  Its a tough question.  My answer was yes and no.  Of course awareness is important, but the kind of awareness is more important. I suggested that she work on raising more awareness about Type 2 as that is a growing crisis for this region.  Perhaps this is why I was not mentioned in the article.

Most of the questions were normal, and genuine.  Except for the pregnancy one.  The guy thought he was funny.  Silence is golden.

I try to answer honestly and openly.  If a question seems hard to answer, just stick to the facts as you know it. In most cases it will keep it at a manageable level if you are having one of those days. Depending on who it is, and how you feel you can decide how much of your cat's eating habits you want to share.

Megan, our diabetic cat