Saturday, November 20, 2010

Thyroid Challenges in the Life of Diabetes

I had hoped to write more frequently about diabetes and how it affects my life and the life of my children.  We have adjusted over the years (both were diagnosed in 2006), but it seems there are still bumps in the road.  We've had a real struggle over the past several months.  Our oldest with diabetes, now 16, has had positive antibodies for his thyroid for several years.  Apparently people with diabetes are at higher risk for other autoimmune problems, one of which is thyroid.

So my son's antibody levels were at 8052, with normal being less than 25!  So we've been watching for the symptoms for over a year (fatigue, irritability, moodiness, changes in appetite, weight changes) and with a teenager it is extremely hard to tell what's what.  Is it normal teenage mood swings and moodiness, or is it the thyroid? 

Well, this last time his thyroid levels were checked, it showed up as being off, so he was started on thyroid meds.  What a struggle it has been for the last few months.  I never realized how much your thyroid does.  We have had to deal with his being so tired, (he says, "No matter how much sleep I get, I'm exhausted."), which results in being late for school, falling asleep during school, etc.  So we are having to deal with problems with school, which is a first for us, as he's always made A's and B's without trying.  And dealing with his mood swings is a challenge in itself.  I try to remember there is more going on inside of him than just normal teen mood swings, and it's hard for him to regulate it right now, but it doesn't make living with it any easier!  Some days I feel like I walk on eggshells trying not to upset him!

But, like diabetes, as his medicine gets adjusted, things are getting better.  Interesting though, since he started on his thyroid meds, his bloodwork has gotten worse.  So they are now having to work on adjusting his dose. The school nurse told me it may take six months to get it all adjusted! 

I wish he didn't have to deal with extra stuff on top of diabetes, as dealing with diabetes as a teen is tough enough, and now he has to remember to take another med each day.  But he's a trooper, as all kids with diabetes seem to be, and goes on with life the best he can.  And we learn new things each day, and I certainly have more compassion for those with thyroid issues, and can see first hand how much it can regulate things in life!

If you have any tips on dealing with thyroid stuff, please leave me a comment!  I didn't realize it was so hard just to remember to take a pill each day!

Tuesday, October 5, 2010

Those Dreaded Low's: How to Treat Low Blood Sugar

I  think one thing that is common about diabetes is the fear of lows.  I remember when my son was first diagnosed and we were taught about low blood sugar, we went home and I dreaded that first low.  I was afraid of what he would feel like, and the worst, what if he passed out and I had to use the glucagon!  But that first low quickly happened in a day or so, and it wasn't as bad as I feared.  He felt shaky and very hungry, but he quickly ate and felt better.  Most endocrinologists want to avoid the lows in kids, but the tight control we aim for frequently  leads to occasional lows.  So just being prepared and knowing what to do is the key.

Most people consider a low to be either less than 70, or with kids sometimes we choose less than 80.  After someone has run "high", such as in the 300's and up, when they get their blood sugar under better control, when they are at 100 they may have the symptoms of lows.  Checking your blood sugar is a must to see if you are really low.  If it reads normal but you are having symptoms, consider whether you are used to running high and try  and wait it out and let your body adjust, or consider whether your blood sugar is dropping and the meter hasn't "caught up" to the blood sugar.  My endo says if you feel low, then treat, whether the machine says it's 90 or whatever.  He says it's on the way down.

Symptoms of Lows:

Can include, but not limited to:  headache, drowiness, trembling, blurred vision, hunger, feeling dizzy or faint, confusion, dazy look, fast beating of the heart, trouble speaking.

If you have any symptoms, or notice changes in your child with diabetes, check your blood sugar immediately. 


Rule of 15:  If blood sugar less than 70 mg/dl (or whatever your healthcare professional has recommended), eat or drink 15 gms of carbs that are FAST ACTING.  Fast acting carbs are a simple sugar which will raise your blood sugar fast.  Examples include:  3-4 glucose tabs, 1/2 cup regular soda, small baggies of candy such as skittles, an airhead, lifesavors, etc.  (I like to buy holiday candy in the fun packs to keep on hand for this)  Don't choose something chocolate or something with a high fat content, as that will slow down the rise in the blood sugar.

Wait 15 minutes and recheck.  If blood sugar has not come up to normal, treat with another 15 grams carbs and repeat process.

If your blood sugar is less than 50 mg/dl, then treat  with 30 grams carbs and follow above process.

If you are not eating within an hour, then follow the simple carb with a snack that contains some protein and carbs, such as peanut butter and crackers.

Always keep Glucagon on hand in case of unconsciousness.  Always keep snacks on hand, in the car, bags, in your child's pocket if he/she is off playing in the neighborhood, etc.  Being prepared is very important for lows.  Don't get caught in the middle of nowhere with no simple carbs on hand.

After any lows, evaluate the reason for low so you can prevent them as best as possible.  Was there too much insulin on board, too much insulin to cover a meal,  was the meal not finished, did exercise affect your blood sugars, etc.  Try and correct the reason to avoid the lows, but know that they are not totally preventable, because life happens!

Monday, September 27, 2010

Top Ten Tips to Manage Your Stress for Better Diabetes Control for Your Child

We all know that stress is a part of life. There are some good points to having stress, as stress can cause us to take action, but an overall high level of stress can cause health problems. We all know how stressful having a child with diabetes can be, from the "off the wall" numbers for no reason, to wondering what to feed them, to dealing with schools and playdates, leaving the house with a bag full of packed diabetes items, and of course, the worse, the 3am blood sugar checks that cause sleep deprivation!  But if you as the parent are overstressed, your children pick up on it.  Reducing your stress can help them have better diabetes control.
Remember, when you take care of yourself, you can better take care of your child.

Tips to Relieve Stress

1. Determine what you can control and what you can’t control. We sometimes waste a lot of time worrying and trying to solve problems that we cannot control. Learning to stop and look at whether you can really change the situation or whether it is out of your control and you need to let go and change how you are dealing with a situation is important. Learn all you can about managing diabetes so you can change what you need to, but also realize there are many other things that are out of our control that affect diabetes, such as hormones, growth spurts, and infections.

2. Take time for you. I frequently hear that it is selfish to take some time for you. I also hear that there is never enough time to do something for you. But if you think about running ragged and never having any downtime or you time, it is taking away from how you are responding to others in your life. By being stressed, anxious, worried, etc, you may be more irritable with those you love, or may not be fully present to enjoy the moments because you are off in your mind worrying about other things. So by taking time for you, you are able to take care of others better. It is like the airplane analogy. Put on your own air mask before putting on your child’s. So make it a priority to schedule some you time. It can be something simple like a quiet cup of coffee in the morning, a hot bath, reading a favorite book, going for a walk, or developing new hobbies. This may mean that you have to train someone to care for your child with diabetes, but in the long run, that's better anyway in case of an emergency with you!

3. Eat healthy and limit stress increasing foods such as sugar, caffeine, and alcohol. Also eat regular meals and planned snacks. Skipping meals can increase stress. Many people are not breakfast eaters, so try lighter breakfasts such as a granola bar or smoothie. Seek out a Registered Dietitian if you need help in this area.

4. Try some guided imagery, prayer, meditation, yoga, or progressive relaxation. Guided imagery is a process where you do deep breathing and imagine yourself somewhere pleasant such as a beach. You imagine using all your senses such as feeling the sand, smelling the salt water, hearing the waves and birds, seeing the grass blades blow and waves crash, etc. Even a five minute “vacation in your head” will help relax you. I had a client who told me “I go fishing in my head.” I love a CD available on called Ten Minutes to Relax. It is a quick guided imagery that can help lower stress. Progressive relaxation is a process where deep breathing is used, along with tensing and releasing muscles in order to help you see whether muscles are tense without you realizing it. It helps you relax by releasing muscles. Many audios are available that help walk you through this process. When done daily, guided imagery and progressive relaxation help lower overall stress.

5. Take 4x4 breaks each day. This means learning to take four small breaks throughout the day and do four deep belly breaths. This helps you just slow down and relax a few times during the day.  Also try this when your child do a blood sugar check and it's higher than what you want.  Remember that the number is a tool for managing diabetes, not a reflection on being "good" or "bad."

6. Exercise. Yes, that is the dreaded word most people do not like. But exercise is a great stress reliever. It also can increase your energy level and help you focus better. And it improves your confidence level, which can affect how you take care of your child with diabetes.  Exercise helps lower those cortisol levels and stimulates serotonin. So build some regular exercise into your routine.

7. Be mindful with your meals. This means rather than inhaling your food while working, driving, watching t.v., or doing other activities, try focusing on your meals and enjoying each bite. Take in how your food smells and how each bite tastes. Chew slowly and try to take twenty minutes to eat. Focusing on your senses gives your mind a much needed break, and by focusing on what you are eating, you get the benefit of being more aware of what you are eating and the amount.

8. Give yourself a mini massage. Just take a five minutes and massage your temples, face, and neck. Better yet, have a partner do it or sign up for a full massage occasionally. You will be amazed at how relaxed you will feel!

9.  Prioritize your to-do list.  This can encompass several things.  Reviewing your priorities in your life, putting yourself at the top of the list for self-care, is the first step.  Frequently this can not be a numbered list, but several things have to be equal, such as relationships, self-care, parenting, diabetes, career, and your spiritual life.  When you know your priorities and what matters to you in your life, it will be easier to cut things off your list that are not in line with your priorities.  Getting some help and delegating items is also essential.  It does not help your stress level to think you have to do it all!

10. Find a support person. Find someone you can trust and share your thoughts and feelings with. When thinking of a support person, discern who a healthy support person would be. This would be someone who listens and is nonjudgmental, not necessarily have to solve your problem but just being present with you, and someone who does not tell you to “get over it.”   Someone who understands diabetes is a great asset, though I know those are hard to find sometime. Having a support group with parents of children with diabetes is a great stress reliever.

Work on lowering your stress to help change your cortisol and serotonin levels and you will see the benefits in your life and your child's. Work on adding in some of these techniques each day, as well as other stress techniques as this is not a complete list of stress reduction. Sometimes people have to actually schedule them on their calendar or post sticky notes for reminders. And don’t be afraid to seek help from a professional if you need more individualized help.

Friday, September 24, 2010

Catch Type 1 Diabetes Early! Know the Symptoms

We were able to catch diabetes early with both our children.  As a dietitian, I knew the symptoms, even though at first I tried to deny that was the problem. But at least I took Josh in to the doctor and the doctor was surprised we caught it so early.  By catching it early, you can prevent DKA and going to the hospital.  Here's a great article on the symptoms of diabetes.

Type 1 Diabetes, Early Recognition, Tell-Tale Signs

Wednesday, August 18, 2010

How to Decrease Pain for Children with Diabetes

Children with diabetes have to do many things that can be overwhelming and scary.  Glucose checks, shots, infusion set insertions, having blood drawn at the doctor, and many other things can be scary for children and tough to deal with as parents.  The "Wow and How" technique is a simple way to help make things easier at times.  I used this with my daughter and now I have something I can easily say to help her, by simply asking "What are you thinking about this time?"

The "Wow and How" is used by therapists more with children who are frequently hospitalized and have to undergo frequent medical interventions that can be painful, such as those on chemotherapy.  But it can also be used easily with other populations.  It is a very simple technique, yet it helps the child learn new ways of dealing with pain and fear.

Here's how to do it.  Simply observe when your child is doing something that usually upsets him/her, then notice when it does not hurt as much.  Reflect this to your child, saying something like "Wow!  I notice that didn't hurt as much!"  Then listen and reflect back what they say.  (Just rephrase what they say back to them, not adding any judgement to it.)

Then add the "How".  Ask, "How did it not hurt this time" or something similar.  Listen and reflect back to them what they say.  Then help them problem solve how that can help in the future.

Here's an example of my using this with my daughter.
Sara was putting in an infusion set one night.  Somedays this seems to hurt more than others.  We were going through a time when it seemed to hurt more.  One night, it did not hurt as much, so I said "Wow, that didn't hurt as much."  Then I reflected back what she said, and asked her "How did you make it not hurt as much?"  Notice that this lets her know that she has the power to help it not hurt as much.  She said "I thought about the ocean."  So now we have an easy way for her to distract herself for a minute to help minimize the pain.

Try this today and see if it helps and let me know your stories!  Comments welcome, we all grow and learn from each other!

Wednesday, June 30, 2010

Traveling with Diabetes

It's that time of year for vacations.  A favorite for our family is the beach.  Getting a break from the day to day of life is great for recharging, but does require some planning ahead when you have a child with diabetes.  Packing all the extra things can be nerve wracking for me, as I tend to feel like I'm forgetting something. (and at times I have, such as last summer my son went off to a non-diabetes camp as a counselor, and he got there and that night called and said "I only have one test strip left!)  So I always keep a list, so as I think of things to pack, I add it to the list.  Here's a key list of things I have to remember to pack for children with diabetes:
  • Insulin (the obvious here)  Take more than what you think you might need.  Also, I keep a prescription for an extra bottle that I can take to any pharmacy in case something happens, such as it overheats or the bottle gets dropped.
  • Syringes, even if you are on the pump, you never know if you need them for backup
  • Pump infusion sets/reservoirs, inserter if used:  an important tip here is, you can not buy these at any pharmacy, so take double what you think you might need.
  • Extra test strips, extra meter, extra batteries for pump and meter.
  • IV prep wipes, or whatever wipes for pump infusion sets you might use.
  • Carb counting books
Again I get this feeling of "I'm forgetting something!" so let me know in the comments section what else you usually take!

Here are some of my traveling tips with kids:
  • Take plenty of snacks for lows.  Keep in mind that if you are in a hotel and a child wakes up in the middle of the night with a low, you don't want to walk out to the car, so have something with you.
  • Have a plan for what to do for activities, such as how long to stay off a pump, how the activity affects your child's blood sugar, what supplies to carry in a bag with you for activities, what to do at the beach, such as put the pump in a ziplock bag so as not to get sand in it, etc.  Some of these need to be discussed with your doctor ahead of time.
  • Things to discuss with doctor: 
    • What to do when the pump is off for an extended time, such as at the beach.  We check our blood sugars every hour and then reconnect and bolus a correction if needed.
    • How to adjust insulin for extra activities, how to adjust insulin if something happens to the pump and you have to go back to shots, whether your child needs extra insulin such as a temporary basal rate in the car if you are traveling for 8 hours or so (we usually put ours at 110% or so since they aren't getting any activity and there blood sugar tends to go up)
    • what to do for emergencies
  • If you are traveling by plane, get a note from the doctor saying your child has diabetes and has to carry syringes, lancets, insulin, snack, etc on board the plane.
  • If you are traveling by plane and checking bags, don't put all the supplies into one bag, divide them up in case a bag gets lost.  And have plenty of supplies in a carry-on.  I know someone who went overseas and had all their supplies in a backpack, and it was stolen!  It was a mess getting supplies and insulin overseas.
These are just some tips off the top of my head.  If you think of others, please feel free to add them to the comments for others.  I do have that "I forgot something" feeling!
Enjoy your summers!