March 9, 2013
Lately, in my crazy, tired, stressed-out head, I’ve likened managing diabetes to making Grandma’s favorite cake recipe by scratch…with no recipe. If you get everything right, your cake will turn out perfectly. If you miss one ingredient, or put too much or too little of something, your cake will flop, overflow, or just not be quite right.
Those who don’t regularly deal with diabetes think we just check a blood sugar and give insulin. What they don’t understand or know is that there are so many more ingredients to the process. Forgetting to consider one thing can flop our cake….and our ultimate goal (the perfect cake) is normoglycemia (normal blood sugar).
So, here’s the recipe:
First , you check the blood sugar. Hopefully it’s normal, but don’t hold your breath. (I would’ve died from hypoxia a long time ago if I held my breath!) When deciding on how much insulin to put in the mixing bowl, you primarily have to consider the carbohydrates the child is consuming. So, much like the flour and sugar are the primary ingredients in baking your cake, the current blood sugar and carbohydrates are the primary ingredients in dosing insulin.
But, if you fail to use or consider other smaller ingredients, your cake flops. Baking powder, eggs, oil, milk, cocoa powder…..etc. Our “ingredients” are intrinsic and extrinsic. Some we can control, others we cannot.
As diabetic parents, we have to consider the level of the blood sugar. High ones require more insulin, low ones require less insulin.
We have to adjust for extrinsic factors:
· The TYPE of carbohydrates (Simple or complex, each of which impact the glucose level differently and at different times).
· The fat and protein content (High fat or protein meals make the glucose spike HOURS later!).
· The child’s current and future activity level (Running around like a madman uses up all the circulating carbohydrates and causes a rapid glucose drop).
· Growth. Size of the Child. Hormones.
· The site of injection of insulin.
· How Mom is holding her mouth and the color of her shirt.
· What the child had the prior meal.
· The amount of hairs left on Daddy’s head.
You have to consider ALL of it. Gather all that together, and throw it in the mixing bowl.
Then you stir the ingredients with your Math-VooDoo-Sorcery-Science spoon. Slow down! Not too many stirs, not too few. Pour the mixture into your cake pan (read: diabetic child) and allow to cook in the oven.
What’s going on intrinsically in the “oven” that will impact the outcome?
· Is that “oven” growing?
· Developing an illness?
· Is his brother irritating him? Are they all irritating me?
· Is now a HORRIBLE time for his Omnipod to fail? (If so, you can guarantee a failure and the dreaded screech of death!)
· Having a “leftover” fat or protein spike from another meal?
· Have a few remaining functioning beta cells today that decide NOW is a great time to fritz out?
· Sheer stubbornness of diabetes to cooperate and adhere to logic and reason! (It's quite a stupid disease!)
Any and all of those intrinsic factors can make or break your cake.
In one to four hours, check your concoction. Did it flop (go too low)? Did it overflow and burn inside the oven (hyperglycemia) (leaving you yet another mess to clean!)? Or, for one rare moment, was it just right?
No two days are the same. The same meal can impact him differently on different days due to those intrinsic and extrinsic factors. Success and failure. It’s baking a cake without a recipe. One day the cake is great, the next day you wouldn’t feed it to your dog!
But, as T1D parents, we persevere. We add more carbs, less carbs, less insulin, extend the insulin’s actions, we stir more, we stir less. We try dancing, holding our mouths differently, wearing a different colored shirt, giving Daddy a toupee, and drinking wine…WHATEVER it takes to achieve the elusive goal of normoglycemia. And some days, we actually get it right….THAT is our icing on the cake!