Book Review: The Thyroid Solution Diet

The Thyroid Solution DietFirst off: Don’t let the title throw you. This book is not just about the thyroid or those who suffer from thyroid related issues. Second: Anyone interested in extending their life should read it.

I have for years, since well before Lia’s diagnosis with Type 1 diabetes, been interested in the connection between food, exercise and physical health and this book, which falls along the same lines of Gary Taubes’ Why We Get Fat: And What to Do About ItDr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars and anything by Michael Pollen, does a wonderful job explaining it using both science and a keen ability to speak in terms any layperson serious about their health should be able to understand.

Though the book does not speak directly to people with diabetes (and where it does it is doesn’t differentiate from type 2), it says volumes about insulin and maintaining healthy blood sugars. It is, in short, the hard stuff I wish our endocrinologist was either trained or knowledgeable enough to discuss with us. But Franca and I learned early on that taking care of diabetes meant TAKING CARE of diabetes. Not signing that task off to someone else.

But back to the book. I was much more interested in the first two-thirds in which Arem goes into fabulous detail about sugar, fat and how these foods breakdown and based on various factors combine with the body’s multitude of hormones (but especially insulin and leptin) to regulate/affect/and in many cases generally muck up the body’s natural metabolism (i.e. Garbage in. Garbage out, which reminded me a great deal of Alejandro Junger’s, Clean: The Revolutionary Program to Restore the Body’s Natural Ability to Heal Itself, which I also highly recommend from personal experience). The last third spells out specific recipes, which I may or may not use, but offers to those not interested in coming up with their own menus, excellent examples of not only what to eat, but when to eat it. Great information to anyone, regardless of what state their personal health is in, in terms of converting food to fuel as opposed to fat.

While I don’t agree 100% with what he says—for instance, I don’t follow the low-fat-is-better-for-you theories on health—rarely have I found a food book that speaks so clearly in terms of sugar, fat, hormones, and exercise, and also of aging, stress, sleep, and detoxification and the affect these have on not just our pant size but our mood especially. And that (the mood, not the pant size) is something we all can relate.

Just Around the Next Bend

As Steve mentioned a few weeks ago, we packed up the gear and the kids and headed off to the mountains of Southwest Virginia for some much needed back-to-nature time. No cell phones, no computers, no television or Red Box. A chance to detox from the connections that keep us firmly rooted in our busy lives. And also the opportunity to remember that there is a great, big, beautiful world out there and the best entertainment is often the sharing of stories with those with whom we share it.

This was our second foray into the wild with diabetes and to be honest we felt like pros. Meals were planned to the nth detail, the food pre-measured, pre-packaged and pre-labeled, and in some cases even pre-cooked. The load divvied up amongst us. Supplies checked and re-checked. Our plan for managing all things diabetes researched, discussed and settled. All that was left was the leaving.

In terms of blood sugar control, we opted to try something new: dose 100% for the food Lia ate, and use negative temp basals to reflect the increase in activity. This turned out to be a better plan than last year’s and easier to manage. The first half-day, we only put the temp on for four hours and then forgot to renew it, so she battled some lows later in the day. For the rest of our trip, we put on temps for twelve hours before we left for the day and this worked out perfectly for the most part:

By the Numbers (Data from Diasend)

Average Blood Sugars While on Trail: 153
BGs within range: 67%
BGs above range: 16%
BGs below range: 5%
Average daily basal insulin: 8.2 U (a full 2.3 units less than at home)
Average daily bolus insulin: 11.5 U
Average BG correction: 8%

The Hike

We hiked a total of 22 miles: 8 miles the first day to the top of Mount Rogers; 8 miles the second day to the Scales; and 7 miles the third day back to our car (two miles on VA 603).  Both girls did a great job keeping up and staying in high spirits, even when feet and backs hurt from the rocky terrain and from the climbs and descents.

On the first day, Lia hiked all day with her pants on backwards and didn’t even notice until lunch. She also fell over once when having to get over a fallen tree and needed help getting up from her overturned turtle position. Our hike was mostly uphill, and rocky only in places. The night was cold but not unbearable and it took us longer to get up and going on the second day than on the first. We lost time and had to adjust our route by cutting across the park on a horse trail, which in hindsight was a bad idea.

Horse trails, designed for horses, are filled with large loose rocks that are difficult to walk on. The horse trail was four miles long and muddy. At one point, Steve was out front and saw a copperhead snake. He turned around just in time to see Lia nearly step on it! Their quick reaction saved her from a snakebite and a disastrous end to our trip

(and possibly an upcoming plot line for a novel). We were all shaken so much after this that we just wanted to get to our destination and take a load off. The four miles felt like eight and Steve’s near-constant assurances that Scales was “just around the bend,” made Krista and I want to scream.

Change in Plans

We love Southwest Virginia. The beautiful vistas we saw during our three days were some of the most breathtaking views we’ve seen as a family. We saw our favorite friends, the feral ponies of the park. At Scales we encountered 50-60 heads of long-horned cattle, and continued to hear their lowing long into the night when a mama and her young were separated at dusk. Unfortunately, on the second day, our memory card malfunctioned and all the pictures from the first two days were mistakenly erased! We did manage to take a few on the last day.

On our last morning, we awoke to frost and a temperature of 25 degrees! Before the girls woke, Steve and I decided not to spend our final night at the campground as originally planned, but to head to West Jefferson, NC for a night at a hotel.  We ate breakfast and everyone was ready in record time. On our way down the mountain, we encountered a young man who was through-hiking the Appalachian Trail with his beautiful black German shepherd, as well as several other

campers who were short-term hikers like us. The last two miles on the road were brutal. We were once again subject to Steve’s continued assurances that the end was “just around the bend.” We were happy to finally see a sign designating the Grindstone Campground.

For all the preparation and work that we put into going on our trip, nothing compares to going to the great outdoors. It sounds like a cliché, but the clean air of the countryside, the reduction of noise and light pollution, allowed us to see things we would ordinarily miss. We noticed each other, our idiosyncrasies and habits, manner of speaking, and things we say. We listen.

And yes, diabetes, our unwanted companion, is always along for the ride. But the planning, preparation and organizing we do in advance allow us to put diabetes second, and Lia and Krista time first.

To say that we enjoyed our trip is an understatement. For three days the girls didn’t bicker, they rarely complained, and we, the parents, did not need to scold. We were surely tired when it was over, but this is the one time a year that we truly reconnect, without electronic intrusions of any kind. We are connected through our disconnectedness. We live simply and purely for these days, and we are better for it. We feel confident that we can plan for even longer trips, even if diabetes has to come along for the ride. It is Lia’s favorite activity that we do as a family and this year it has made me think of the old Steve Winwood song. It is true that life goes on too fast with these trips we hope to slow it down.

“We’ll be back in the high life again
All the doors I closed one time will open up again
We’ll be back in the high life again
All the eyes that watched us once will smile and take us in
And we’ll drink and dance with one hand free
And have the world so easily
And oh we’ll be a sight to see
Back in the high life again”

Metaphorically, that is.

 

For those interested in our supply lists and menus, here they are:

Supplies

  • Glucose meter w/ test strips, lancet device, extra lancets
  • 2 spare infusion sets 2 syringes
  • 2 vials of 50ct test strips 1 vial of insulin
  • spare meter extra batteries for meter and pump
  • glucagon kit spare battery cap, spare cartridge cap
  • Emergency info, copy health insurance card, and prescriptions
  • glucose tabs

The Menu

  • Dinner on Friday:  Fried chicken, potato chips
  • Saturday
  • Breakfast: Whole Wheat Bagels with cream cheese (with chives, bacon, and sundried tomatoes)
  • Lunch: Veggie Burgers, dried apples
  • Dinner: Gnocchi with sage butter, bacon, and sundried tomatoes
  • Sunday
  • Breakfast: Apple Almond Couscous
  • Lunch: Ollalie Wrap (spinach and whole-wheat tortillas, cream cheese, roasted pepper pesto, and Israeli couscous, with bacon)
  • Dinner:  Manly Man Orzo
  • Monday
  • Breakfast: Strawberry Almond Couscous
  • Lunch: Esmeralda wrap (spinach and whole wheat tortillas with cream cheese, avocado, sundried tomatoes and bacon)

Snacks

The Kitchen

  • 2 stoves
  • 2 pots with lids (1 small, 1 large)
  • 1 serving/stirring spoon
  • 4 sporks
  • 4 bowls
  • 4 cups
  • 1 cutting board
  • ½ sponge
  • camp dish soap
  • 4 small cloth placemats
  • 1 wiping cloth (for drying dishes)

 

A Lesson on Atoms
(or Letting Go)

When it was early summer vacation and close enough to the end of the school year for Lia to still be considered an elementary student and not a rising sixth grader Franca and I weren’t sure what changes we’d make to her diabetes care plan to meet whatever new challenges arrived with middle school. Other than a few frustrating moments—a teacher withholding candy for some asinine reason, the immaturity and arrogance of young boys, chaos around the lunch bolus—school and her diabetes for the most part had gotten along. At least there were no panicked drives across town or phone calls that made us question why in hell we weren’t home schooling (not that had to do with diabetes anyway).

In fact, Lia’s school does a pretty good job of making us both feel like we’re not wasting our time sharing with them—sometimes more than once—facts about highs and lows, helpful tips for teachers of students with diabetes, unique details of Lia’s own treatment and management of her disease. They appear interested, concerned. They ask questions for clarification, offer personal testimony and eye witness to Lia’s strong character, her stoicism, her quietude and composure. By their words, or mostly with just their silence, they acknowledge this one true thing: In terms of diabetes, Lia is in charge.

It’s a question of independence and one that her mother and I were, and still are and will be for many years to come, struggling with as we sat down and talked about the upcoming school year. To understand why you must first have a child and then that child must get sick and be diagnosed with an illness for which is there no cure. Only then will you understand a parent’s worry of letting go. There is no other training for this, no software simulation that will help you understand. And, as I’ve alluded, children with diabetes make taking care of it look like a breeze. Poke. Test. And Bolus. Move on. Next lesson, please.

I’d like that to (but it won’t) help you appreciate our routine for the past couple of years which has been for Lia to call from a phone in the classroom, or the office, if necessary, and talk with one of us about her blood sugar before she does any bolusing. Same with lows. Call, then correct, or correct if you have to but give us a call right after. Because there is no school nurse, it’s just what we had to do. It’s what made us feel safe, because we were in charge, not Lia.

With age comes change however. Like atoms, of which humans are made up of many (about 7,000,000,000,000,000,000,000,000,000), diabetes is not something that can be divided. We cannot take some, say just the parts of it that keep her safe and sound, and leave the rest for Lia (those parts that let her cut in line if she has to pee, or drink juice during English class). As she gets older she’ll gradually assume more and more of the whole until there is nothing but worry and hope that is left for her mother and father. I don’t like it and would do anything to change it, but it is what it is. I can’t fight it. But what we give up we give up in the smallest of increments.

Already Lia is showing signs of her readiness—wrong word. Surrender, perhaps is more fitting—to take on more. So for middle school we’re giving her a new tool to help her succeed, but at the same time still keep us informed. With a cellphone, she’ll no longer have to endure phone calls standing in the doorway next to the hall, where kids are pushing and shoving past, jockeying in the way kids do, while trying to share with with me her blood sugar number. She’ll no longer have to take time out of her measly lunch period fielding questions from me that usually start with: So, how’s it going? As if I forgot she’s at school, and not a sleepover at Grandma’s.

Now—she’s been back to school for four weeks—she texts us from her seat. Before or after she eats, sometimes not at all, but those rare occasions we remind her of our expectations. She texts us, too, if she goes low and has to correct. She texts us other things as well—”Can BB (her friend) come over.”—but mostly she keeps her messages on topic, so she can get back to the things that a middle schooler finds important, like how in the world did anyone ever arrive at a number with twenty-seven zeroes. Okay, maybe that’s not exactly important, but it is, at least momentarily, a bit mind-boggling. Which will likely for her and most others pretty much sum up middle school.

Hulk Smash

Yesterday I wrote about Franca and Lia and their strength and indomitable spirit to stare down the maw of diabetes no matter what, any day of the week, standing firm behind the motto: You want a fight? Bring it. For day 3 of Diabetes D-Blog Week the focus shifts to development, a topic for which I will turn the attention to me.

I am by no means a tinkerer. I have no patience for the preciseness it usually requires and would rather do just about anything than spend my time fine-tuning, adjusting, or otherwise engaged in the activity of repair. For me, playing the guitar (if that’s even what I should call it) is about as much experimentation as I care to do. Life, I believe, is to be lived, not calibrated. Besides, my Dad didn’t know how to fix shit and never taught me and so despite my collection of sockets, screwdrivers and power tools, I’d just as soon leave them in the packaging they came in. As it is for the most part, they’re just cluttering up the garage. If something is broken or out of tune, my preference, or should I say, my skills would lend to smash it and start over.

But if anything taking control of diabetes requires a good bit of routine and extra fine-tuning, let’s call it D-regulation (don’t say I never reach across the aisle). The things that can and should be governed are as confusing as they must sound to someone unfamiliar with diabetes. Total Daily Dose. Insulin to Carb Ratio. Correction Factor. Twenty-four hour basals. Insulin on Board. And so on and so forth. Each of these  elements weighs heavily on just how effective we are at managing Lia’s blood sugars. Changing the settings of just one of them could mean the difference between this (thereabouts):

______________________________

or this:

Engineering all those factors to obtain level blood sugars depends upon the precise application of tiny little tweaks, not smashing. You make one little change to just one of those elements (not six), wait a few days and see what happens. Didn’t get the results you wanted or expected? Make another little tweak, wait some more. It should feel like you’ve gone back in time and are trying to tune in a television station by ever so slightly adjusting the antennae rabbit years, not banging the crap out of the side of the box.

With diabetes I’ve got to change my attitude and techniques. Lia is ten now. Next year she wants to do cross country. Then her teen years are fast approaching. Smashing won’t work. Smashing will work against us. It’s time the Hulk in me developed a little more patience.

Too Little, Too Soon

In spite of her diabetes, for Lia, life is pretty simple. She loves to take walks up the road, fish off a dock, and she’ll still will occasionally host in her room a miniature tea party for two. If a person is kind to her, she’s kind to them back. She never says, “but it’s complicated”.

Riva Greenberg wrote an interesting piece earlier this summer (and which appeared last week at A Sweet Life) on a disappointing experience she had using a continuous glucose monitor, and it reminded me of our own brief and unhappy history with one of these hi-tech devices.

About eight months after Lia was diagnosed with T1 and only six weeks after going on the Animas Ping, our CDE suggested we give a “blind” CGMS a go. Franca and I agreed, after all, what in the world did we know about diabetes management. We were still wrestling with its very presence, and on top of that (disqualifier), we thought it’d be good information to have in helping us configure the settings and maximize the power of the pump. Unfortunately, it appears, heightened emotion and naivete are two sure signs that other than the experience of trying something new, very little good will come of the extra effort. Now we know.

For starters, the device was just too big. Lia hated it and its presence, in her mind, was inescapable. She could not forget it was there and so she scratched and scratched at the area, clawing her nails over and around the little contraption until she had managed to unplug, as it were, the business end of the monitor, rendering lost the last day or two of information, a fact anyone had failed to realize until the nurse at the endocrinologist’s office saw the missing days in the data, or rather failed to see the data. In our mind, even one second spent in discomfort or otherwise hampered by diabetes is one second too much. Strike One.

Though our endo’s office had assisted us in initially programming the pump’s settings — one carb ratio, one insulin sensitivity factor, three basal rates for a 24 hr. period — it became pretty much up to us to figure out how to fine tune them. Ignoring (for now) the gross dereliction of duty I now believe that was, setting up a pump is no simple small task, no matter how long you’ve had diabetes. Six weeks later we were still chasing numbers all over the place, correcting blood sugars day and night. The fact of the matter was, it was just too soon for us to be test driving the newest technology. Going to a pump from shots is not the same as say, switching from a stick to an automatic. We were still trying to figure out the complexities we already had. Were we ready to try a CGM? No way. Strike two.

And finally was the data itself. As this was a blind CGMS, the readings were not provided to us in real time. It wasn’t until two weeks later at our endo’s office we were finally able to see them. Without going back and comparing our logbook to the data the CGM spat out, there was no way to know if the thing was even calibrated correctly. For sixty bucks, I honestly expected more than that. End of story. Strike three.

Like Riva, Franca and I would really love to have a CGM in our corner. It’s something that should be in every parent’s corner. Taking care our children is hard enough without using all available resources. Unfortunately, we’re not looking to sign one up anytime soon, and it wouldn’t matter if we were, Lia’s experience turned her off the idea anyway. In her mind the rules just aren’t that complicated. Three strikes, you’re out is plenty enough.

The Bright Side

This is a tough one. Today’s post for diabetes blog week is to write about something good that diabetes has done for Lia. The problem I’m having is that accomplishing this tiny task is made a bit more difficult by any number of obvious reasons: It’s a disease. It’s incurable. And mostly it acts like a dick. So it’s kind of like asking the guy who got shot by Dick Cheney to be thankful for the face-full of lead because the quail hunt he was engaged in with the VP wasn’t going all that well for him.

But I get it, positive thinking is all the rage today and so in setting the whole chronic, dick-headed disease thing aside, I wonder where to begin in revealing the flip side of the coin, that is the bright-sidedness of diabetes.

Should I start first with the physical and mental courage it takes to confront diabetes everyday? Courage to endure pain. Courage to not be intimidated. Courage to face fear and take measure several times a day, through the tiniest pinprick of blood, of one of life’s greatest and most ultimate uncertainties. But is it fair to say that courage sprouts out of hardship, or is it already inside us, and rises forth like a bad-ass commando out of the depths and fog where it’s been keeping watch all along?

If not courage, then what of humility? It cannot be easy sharing the stage with such a pinhead of a co-host, when diabetes behaves like a persistent April Fools joke, acting contrary every day of the year. How else do you explain the steadfast grace needed to put up with such mischief if not with humility?

Or might the gift from diabetes be best described as empathy? This is one I could point to were it not like saying in order to better understand the blind one must walk the world with their eyes closed. Honestly, empathy needs no point of reference, just as hope needs no foothold on imagination. They just are, if we let them.

So where does that leave me?

Gratitude for the fact that diabetes is not something worse than it already is?

The experience of overcoming one struggle so that it makes her stronger for the next?

The motivation that turns fear into an advantage?

An appreciation for life?

A sense of community?

The peace of self-content with what is versus what should be?

The truth is Lia is who she is in spite of diabetes. Putting a positive spin on this life-threatening condition — while invigorating to write about — feels strangely like falling into the trappings of a culture driven by the ideological desire to find something happy in everything (though the numbers suggest otherwise). But how can I not play along, if only to satisfy myself that I did everything I could for her physical and mental well-being?

Yes, she’s stronger.

Yes, she has more courage, more empathy, more appreciation, more everything.

I would steal for her the naming rights to whatever life-affirming attributions have yet to be identified if it could mean that for just one day she didn’t have to think about diabetes. But it’s just not that easy. I say so not because I’m a pessimist, I’m not. I believe very much in believing in yourself, and I understand also that in taking this position, I might be making a serious leap in linking my daughter’s regard for her diabetes to a half-century of national schooling in what could be described as social optimism pumped-up-on-steroids.

Seriously, though, I know, I’m taking this too far, and probably out of context of what was the intended assignment. Maybe this whole diabetes thing is still just too fresh for me. Maybe I’ve worked myself into a tizzy because I haven’t yet fully bought in to the critical importance of finding something good about this thing that will be with my daughter the rest of her life. No, that’s not true. Will be with her until there’s a cure.

But I know also I’m not alone. When Lia gives herself a shot or pricks her finger for the umpteenth that day, she does not think of the bottomless well of courage such an act requires of her.

When she feels low, she doesn’t appreciate the fact that it could be much worse.

When she explains again and again to her classmates what that thing is on her hip, she doesn’t think: Because of this, I’m a better person.

She thinks, like I do now, or she will at some point one day: This shit totally blows.

And so speaking to her as her father, mindful also that I’m not one who has diabetes, to help her get through those days where she feels downtrodden and out of sorts, I would say: You are many things, sweetheart. Brave. Smart. A true fighter. You were these things before this moment and you will be these things long after it’s passed. Diabetes doesn’t give you strength. It doesn’t give you courage. Everything you need to get upright and get through these times is dwelling inside where it has been, like the mettle of this little guy, making you you all along.

Speaking of Dogs

Take diabetes, for instance. In many ways, raising a dog is a lot like controlling blood sugars, minus of course the extreme health risk. You study the science. You learn the technique. You get up every day determined to do your best and when things go the way you had planned you celebrate. You applaud and pat yourself on the back. Maybe you even dance and talk silly. Whatever shape it takes, you know in that very moment you’ve done something right. And if it goes the other way and not as you’d intended? Well, you might wonder perhaps, as I’d done with the dog: What on earth did I do wrong.

I find myself doing that more than I should and I hope that my feelings of underachievement go by Lia unnoticed. It is something that comes with parenting, I think. Wanting the best for your children, disappointed when you fall short. Even when something like blood sugar can’t always be explained. Trying to understand why it goes up or down is like asking Jake to account for his running off and then, because knowing why is only half the battle — it still doesn’t fix it, you have him describe what he saw. He just looks at you.

The alternative to that is easier, but frankly no less productive. Such was the case when Jake finally returned and I saw him out front in the yard, tearing through the trash bag containing the shells of moules à la marinière we’d had the night before. I stomped and got blistering mad and banished him for good to the outdoors. By dusk I was over my anger and went out to clean him up, only to find him gone once more.

Oh, were yelling to work with diabetes. I could curse and threaten and abandon all thought of ever showing it kindness again, but it would not listen and before the day would turn over, I’d have shed myself of the disillusion and disappointment and let it back into my heart because so much of who we are is not chosen but given or comes to us freely. In learning to accept that about diabetes, I have also learned to love it.

That is a strange thing to say. I love my daughter’s diabetes. I don’t, of course, love it. I hate it. I despise every moment that I or my wife or Lia, or anyone else, has to spend trying to understand and outwit it. I wish it were different for all of us, and especially for Lia, but wishing won’t change anything and if it could there is one thing I would not want for and that is that she were any other child or I any other parent. I love her and so love all that comes with her.

As for the dog?

Commitment. Loyalty. Obedience.

Two out of three isn’t bad.

The Fixer

I am having a problem with our dog. You might remember Jake. I wrote about forgetting him as we left from a holiday weekend visit with some friends at their lake house. Jake is a pretty mellow dog. He follows me around the house, lays under the desk while I write, and other than shedding, sloppy drink habits, and an audible and extremely aggravating nighttime routine of self-cleaning, he’s fairly easy to accept as far as most family pets go. But lately he hasn’t been listening.

Now, before you say anything, I know this is probably my fault. Like most everything in and about this house, he doesn’t get enough attention. I know that. We worked with him a good deal when we first brought him home from the pound, struggled hard to get down to the bare bones of what makes a good dog tick, and for a while he did really well, and us, too, with his training. With some basic behavioral understanding and simple commands, we could get him to sit and lay down and come to a whistle. Some days he did better than others. Some habits we simply couldn’t get him to break, such as chasing after cars if one happened to invade his immediate space. Other things, for whatever reason, like learning to shake, were difficult to grasp and took a great amount of effort on both of our parts. With practice, however, we managed and eventually even the hard things became simple, too. But something in the last year has changed. I just noticed it in the last few weeks, but I think it’s been building up over time, this will to not do what we say.

In the likelihood that some animal expert out there will suggest it, I’ll be the first to say, I get what it is that I ask for. And all that I ask for from Jake is the same that I’d ask of any addition to our family: play nice. In return, I don’t make of him ridiculous requests, or ask that he do something that’s impossible, as in, say, talk like a pirate or go get his own damn breakfast. I give him his freedom to act like a dog and he gives us his love and companionship. It’s a shared responsibility, which is why yesterday morning when I asked him to come and he looked at me and saw what I wanted but just stood there staring back at me, until I told him to come once more, in a voice more suited for commanding authority, and he turned and ran away — and then stayed gone for hours — that I simply could not believe it.

How could this be? We had worked so hard. We had an understanding. We had accepted him and his imperfections and though our arrangement with him was not ideal, what with the lack of time and attention, there was never a shortage of need or respect.

They say a dog’s motivation is tied closely to its social order, that is, how goes the pack goes the animal. If that’s true, and I believe that it is, then we do have ourselves to blame. But it’s not the question of blame I am searching to fill. I just want what’s wrong to be fixed. I want him to listen. I want what we have in our lives to play nice and if not, at least have a good reason.

Perhaps if we could trade places, Jake would see that I only want what’s good for him, too. The world is a dangerous, sometimes godforsaken place. It is full of  unwelcome things that want to invade our space. It’s important we all stick together. And on my end, I think maybe it’s time to dust off those books and training manuals, because in them, I’m sure, there is something I missed and like anything else in this life, if you give a thing an inch it’s bound to take a mile.

 

The Genius of Intuition

There is something I just don’t get yet. For as long as we’ve been administering Lia’s insulin through a pump we routinely find ourselves relying on intuition when determining her dose. A word problem of how this happens might look something like this:

Lia and her dad are on a field trip to visit a Native American settlement that had been founded and recreated along the banks of a very old river. It is a three hour car ride from school, for which they program a +30% temp basal. They arrive and while watching a documentary film of the tribe, Lia indicates she’s feeling shaky. Fearing a low, they apply an alcohol swab to her finger and check her blood. It reads 331. To bring it down, the pump suggests a dose of 4.10 units of insulin. The two of them talk and decide that 4 units is just too much, especially for the way she is feeling. They agree on a dose half that number. They finish the film and go outside and stand in the rain to watch a demonstration of primitive hunting, after which it is lunchtime. Ninety minutes has passed since Lia received the dose. Before eating, she checks her blood and the meter reads 64. Lia and her dad share a perplexed look with one another. With almost one full unit of insulin still on board, what might have happened had they given the full amount?

It may be that Lia is still honeymooning, though her endocrinologist thinks not. It may be the first reading was just wrong, perhaps her finger wasn’t cleaned properly, maybe it was a meter accuracy issue.

Or it could be that treating diabetes isn’t really just a matter of science. It requires more than mathematical logic and the relationship of quantity, patterns and conjecture, but must also take into account the most primitive and genius of the human condition, the element of instinct.

Not to take anything away from science. It is science that made the field trip that Lia and I were on even possible, without it the village would’ve stayed lost forever. But just as emotion and intuition were certainly a part of the people of that great settlement, and possibly even its demise, I wonder where in the complex world of artificial re-creation does the word hunch fit in.

On November 14, World Diabetes Day, Juvenile Diabetes Resource Foundation Advocacy is hosting Type 1 Talk in an effort to bring type 1 communities together from across the country for a lively and engaging discussion on various pertinent topics. To join the talk on Facebook and host or find your own Type 1 Talk event click here.

If you too use intuition for treating diabetes and would like to suggest your own question for the moderator or cast your vote for Without Envy’s suggestion, click here before the end of the day today, October 22, and under topics search: emotion.

At A Glance

Back now to the daily opus of attention paid Lia’s diabetes. Her wellness of course is always on our minds and as such our strategy in treating the disease is simple: be open to anything that will multiply our opportunities to know it, treat it, and deal with it better emotionally, mentally, and physically.

So last week we took full advantage of a four day test run on the iPro Continuous Glucose reader from Medtronic. This is a small device, shaped like a horseshoe crab but much smaller, about two inches in length, that attaches to the skin and continually captures blood sugar readings, while the person with diabetes goes about their normal routine. At the end of the test period, the CGM is removed and the data downloaded to a computer, where it is analyzed and compared against other collected information such as exercise, food and insulin intake, so that patterns of glucose fluctuations can be marked and adjustments made to the diabetes care plan.

Though we don’t have the data yet and cannot attest to its usefulness, the alternative testing to CGMS involves skipping meals and/or testing each hour for four to five hours, making bolus or basal adjustments, and retesting. Not something Lia or anyone else in the house was too excited to undertake. So at our last quarterly checkup we asked about the CGMS. The staff supported it and a month later she was outfitted (the tape was the worse part of it; see a few poorly shot photos here).

Outside of the obvious interest in learning more about how Lia’s blood sugars behave throughout the day, is how we all sleep at night, or don’t as the case may be. That last comment will ring very familiar with some, but to others I should explain. To do that I’ll need to backtrack.

I mentioned before our eagerness to learn all that we can about Lia’s diabetes. That’s true in every aspect of her care but one: Nighttime lows, which makes little sense when you consider that during the waking part of the day someone is always with her. Should we not be more concerned of those times when someone is not?

But other than arming ourselves with an understanding of the likely causes, nighttime hypoglycemia remains a weak link in our armor against diabetes. I don’t know why that is. It may have to do with fear (here’s an excellent  post about fear); or it could be that ignorance is truly bliss and to be any wiser is folly. After all, isn’t our world affected enough with the knowledge that lows can and do happen, anytime day or night, and the consequences can be fatal? Is that not all the call that is needed to get one of us up once or twice after dark to check Lia’s blood sugar levels? Would any more general knowledge — frequencies of occurrence, tales of courage or loss, the likelihood that Lia would wake on her own if she happens to go low, or even a computer-generated chart of her nighttime averages — give us the prudence to sleep straight through?

It is probably not information that would be wasted. It would be rare if that were the case. The treatment of diabetes is a lot like fighting a war: to avert disaster, know your enemy and know yourself. But is a four day clinical test substantial enough to put to rest any worry?

At a data-collected glance, the most challenge we have with her blood glucose levels are just before she goes to bed. Most of her meter readings — seventy-five percent last week, including those taken at two a.m. — are in range. There was only one case of hypoglycemia and it was minor and could be easily explained (incorrect bolus at breakfast time). She wakes most mornings within a few points of her target.

So maybe our worry is unwarranted. Maybe we’re losing sleep over nothing. Our bodies and sometimes our minds scream out: Yes, yes, you are. But our hearts cry something other.

The security of knowing first-hand, of really knowing that she is safe and sound is a thing no parent can truly relinquish, not to stories or knowledge or detailed computerized data.

Fear sometimes is impossible to let go, regardless how much you know.