Should you give yourself more or less insulin if you’re sick? What if you can’t hold anything down at all? Are “sick day rules” different for people with type 1 than type 2? Dr. Edelman explains what to do when you have the flu.
My daughter was diagnosed with Type 1 diabetes at the age of five nearly three years ago. Needless to say, this event upended our lives. We suddenly had to perform round-the-clock rituals just to keep her alive. We lived with constant fear of hypoglycemia, and we could not escape the reality that one small misstep could lead to seizure, coma, or even death. (Never mind the more remote threat of long-term complications.) These psychological and emotional burdens were compounded by financial ones. We quickly realized that diabetes is expensive—very expensive.
Diabetes’ tentacles reached far and wide, impacting my and my spouse’s professional lives, as well as our mental and physical wellbeing. It wasn’t long before we each developed our own stress-related health problems. As I’ve written elsewhere, I believe that these were psychosomatic. Sigmund Freud was right to call the body a pedantic symbolist. When one feels helpless, one can become helpless.
Over the years, we’ve found ways to take better care of ourselves while also taking care of our daughter—and our son, who does not have T1D and who too often feels like an afterthought. Of course, each day is still a struggle. We all move mountains every day just to manage diabetes. (And I use the word “manage” loosely.) But there are opportunities to take some of the sting out of diabetes. Here are a few of the routines that have most improved our lives:
1. Giving Our Child Options
Our daughter has T1D; hence, she is going to have moments of feeling deprived. There are inevitably times when we have to limit or deny treats when everyone else is eating to their heart’s content. For instance, if her blood sugar is over 400, dessert is out of the question—even if it is Christmas Eve. Because of this reality, we try to give her choices when and where we can. Sometimes, when preparing dinner, we let her select the protein, vegetable, and carbohydrate for the meal. We also include her in grocery shopping. Such small gestures give her a sense of control (however small) over her food intake.
2. Scheduling Time for Our Other Child
As already mentioned, our non-diabetic child is too often in the background. We are so focused on the day-to-day tasks of managing our daughter’s diabetes that it’s hard to keep him in mind, and this leads to further tension. Here’s a sample scenario: my son is trying to show me something he made at school, but the CGM is alarming. So, I acknowledge him with a reply that really means “go away” so I can attend to the more important task—treating the high or low. Then, he misbehaves either to get attention or to express his frustration. Being conscious of the problem helps. So does carving out time for him specifically. If our daughter is at a friend’s house or a doctor’s appointment, then one of us will plan to do something extra special with our son. We look for opportunities to orbit him for a change.
3. Braving Play Dates
Speaking of play dates, how have we learned to manage the tricky hand-off to other adults without diabetes expertise? It is definitely a challenge. I always feel pressure to strike the right balance with information. I want to give enough information to convey the seriousness of diabetes and to adequately instruct the person to manage it in my absence without scaring him or her away. The truth is, some people are scared away, but many are willing to take on the responsibilities of diabetes. In this situation, it helps to provide a cheat sheet for the caregiver to reference and a promise to pick up the phone on the first ring. I also take extra precautions, such as giving a few extra carbs to prevent a low or arranging for more frequent glucose checks.
4. Distancing Myself from Diabetes
Honestly, there is no escaping diabetes. Even when my daughter is under others’ trusted care, diabetes is on my mind. But I have noticed that there is one task in which it is more remote in my mind: reading. Perhaps because reading is so private and personal, it helps to drown out the other noise. My advice to other parents: find something that allows you to retreat. Even if you cannot fully escape diabetes, the distance is rejuvenating.
5. Guarding Downtime
My spouse and I are protective of the weekends and the hours outside of school. We limit organized sports, and we never over-enroll in activities like scouts, camps, or other events that require planning and driving. It’s not that our kids wouldn’t enjoy more activities—I know they would. Frankly, managing diabetes is exhausting, and we don’t have much bandwidth to spare. This may change as our children age, but for now, we just can’t commit. And guess what? Our kids still live charmed lives.
6. Putting Things in Perspective
It never hurts to remember that, just as we are burdened in some respects, we are privileged in others. Our family’s “mountains” may appear like molehills to others. The more fully we appreciate this, the more fully our daughter will, as well.
To read more from Audrey and others living with type 1, visit InsulinNation.com.
What the heck are cure-based therapies? Well, the AP is not a cure but a darned good form of therapy that will bridge the gap until there is a cure. This talk will focus on the area of research that is going for the gold…a real cure…from prevention for our loved ones who have tested positive with diabetes-causing antibodies to the implantation of islet cells. This panel of experts has some of the world’s smartest folks in this space and will leave viewers with some real hope…and hope is where it’s at!
You can’t stop the waves of fluctuating blood glucose levels but you can learn to surf. For those considering or already using Continuous Glucose Monitoring, this talk is for you. Dr. Stephen Ponder, a pediatric endocrinologist and a type 1 himself, takes you beyond the basics and shows you a better way to manage your blood glucose levels. He debunks the myths surrounding classic diabetes management while teaching you a better way. Watch him “Hang Ten”!
The practice of bolusing for just carbs is plain wrong. Yep, we said it! You may not realize that proteins and fats also raise your glucose values but at different rates. Howard will explain to us how different nutrients affect our glucose values and more importantly, how to bolus for them.
What is the best way to know what your average blood glucose has been over the past few months? It is not the A1c test! The A1c test has many faults and, of course, the time in range, glycemic variability, and other measurements for glycemic control are of greater value to those of us with type 1. Irl is an international expert on this topic and will help you demystify A1c.
The conclusion of this debate will be that it comes down to personal choice, but Dr. Edelman will be battling it out with Dr. Irl, his type 1 brother. Expect a lively exchange of information on the pros and cons for each form of therapy. It is important to know this is a real debate that will make you think about your choices for how to control your type 1.
No matter how long you have had type 1 diabetes, complications are something we all fear. You might be complication free but waiting for that dreaded shoe to drop, or you might be dealing with multiple complications and struggling with the guilt and blame. This talk is structured as a group therapy session for type 1s that want to talk about what we all are trying to avoid. Leave your judgment and blame at the door for this emotional ride.
If you are new to a pump or want to hear about new pump options, this is where you need to be. We will talk about the advantages of pump therapy and most importantly how to get the right pump for you. We will also touch on how much (if anything) can a pump be expected to lower your A1c and what a pump can do in regards to helping you with hypos.
Sure type 1s will always need insulin to treat their disease, but is their anything else out there to take that can help us keep our blood sugars in control. The answer is frankly, yes. Come learn about other medications already approved and being studied that can help lower blood sugars, improve time in range, and can help you lose weight! What???????? Yes, it’s true!