Seriously, it's been mostly good

After writing my last post, I felt a whole heck of lot better. I needed to talk about what happened that day-- and wanted anyone reading to be aware of how quickly ketones can get out of control.

And to be prepared if they do.

Well, this post illustrates the flip side-- our norm this summer (vs the craziness of last Tuesday).

A summer filled with drama (the stage variety, that is), swimming, and baseball.

Oh so very much baseball.

While Evan was busy discovering her inner Sarah Bernhardt, Joseph came into his own at the plate, batting over 300 in the regular season and making the All Star team yet again.


He's come a long way... remember this little guy.

This season Joseph continued to thrive on the mound, pitching in both regular season and All Star tournments, but also playing other positions-- including catcher (despite being a lefty!).

And diabetes?

Well, it dished out plenty of highs and lows-- but mostly, it stayed out of Joseph's way.

Soooo, here now is a 3 minute taste of it all...

Enjoy!

When you think it can't happen to him

I need to remember to put the phone by Joseph so I can wake him up to do a check after I'm gone.

(That's my first thought on waking at 6:15 am last Tuesday morning.)

This will be Day Two of a conference I'm attending for my job. The event pulls together folks from citizen advocacy groups across the Midwest. And since most of the work I've done this summer has been from home, this opportunity to learn, share ideas and meet other advocates is welcome indeed. In fact, I rearranged our summer vacation plans so that I could be in town for this thing -- and I'm really glad I did.

I have to be downtown at 8am, the same time Ryan has to be at work -- and Joseph is going to watch Evan for us.

Before heading downstairs to shower, I snatch Joseph's meter and logbook up off my dresser, and step quietly into his room. My boy is stretched out on his futon, face buried in his pillow, when I take hold of his right hand and prick a finger.

368

Wait-- that can't be right.

Whipping open his logbook, I see that he was high all night -- and that he and Ryan did a set change at 2am when he was 398.

Ryan noted that he'd had a bent cannula.

Despite the fact that Joseph has been in the 300s before -- that there have been times when he's experienced a night of high blood sugars, and he's been okay -- I get a sick feeling.

Deep down in the pit of my stomach.

It takes all of 10 seconds for me to run downstairs, grab the blood ketone meter from the black bag, tear open and load a strip, and prick yet another of Joseph's calloused finger tips.

2.1

Oh no.

In almost six years with diabetes, Joseph has never had a blood ketone reading higher than .5 -- a urine ketone strip darker than pink.

Not even at diagnosis.

"Joseph... Joseph... Bud, you need to get up," I say, shaking him gently while trying to stay calm. "You're really high and you've got ketones. A lot of ketones."

Joseph is suddenly bolt upright and heading into the bathroom. Seconds later, he walks back into his room, wide eyed -- holding out a urine ketostick with a dark maroon tip.

"Okay, Bud-- let's get you some water. We need to flush out those ketones."

"What's going on?" Ryan asks, joining us in the hallway.

I fill him in as the three of us move quickly downstairs. Even though Joseph has a new 4-hour old set, and a correction on board, I draw up a shot, inject, then have him sit on the couch and drink a glass of water.

"This is really bad," I tell Ryan quietly in the kitchen-- and as if to illustrate this point, Joseph calls out from the couch:

"Mom, my stomach doesn't feel good- "

He hardly gets the words out of his mouth before he's back up and running to the bathroom. I'm right behind him. He barely makes it to the toilet before he's retching violently. I crouch down by his side and rub his back. When he's done, Joseph sits back, leaning against the tub.

"I feel a lot better, Mom," he tells me in a shaky voice, "I think I just needed to throw up."

And for half an hour, he really does seem better.

But then when I check him again at 7am, his blood sugar is 323; ketones are now 2.4.

Worse -- after more water, he's vomiting again.

We can't do this ourselves.

I grab the phone and punch in the number of the diabetes physician on call at our clinic -- then pace all over the house until finally, 15 minutes later, he calls back.

I give the doc everything -- Joseph's numbers from the previous night (he was 120 before dinner, before climbing into the 300s overnight), ketone levels, the vomiting...

"All right," he says, "it sounds like you're doing all the right things. You need to give him insulin by syringe every two hours, using a sliding scale -- let's not rely on the pump. Also, you need to give him calorie-containing fluids -- watered down orange juice, flat soda... -- and then insulin for them. Remember, the idea is to bring down the ketone levels, not necessarily the blood sugar.... "

"Should we just bring him in?" I ask, trying to keep the panic out of my voice.

"No, I think you may be able to turn this around at home -- but if you don't see improvement in the next 4 hours, then you'll have to bring him to the emergency room."

"Okay," is all I can say. Anything else is caught in my throat. Through tears, I write down the sliding scale for Joseph's injections.

Then I take a deep breath and return to the kitchen.

"Ryan, we need calorie-containing fluids -- the doc suggested watered-down orange juice, but I think the acid is going to be too hard on his stomach. Ginger ale and Gatorade or G2 might be better."

So Ryan heads out to a store five minutes from our house.

And I'm pacing again.

It ends up taking him nearly 20 minutes.

At 7:50am we do another check-- Joseph's blood sugar has dropped to 268, ketones to 1.9.

Thank. God.

I have him drink a small glass of G2, and within minutes he's vomiting again. Bending over him, I press gently on the back of his his neck with a cool, moist cloth. "You're gonna be all right," I say to him, over and over.

A little over an hour later -- at 9am -- his blood sugar is 245 and ketones have dropped to 1.5.

"I think he's turned a corner," I tell Ryan.

"Maybe you can go to your conference," Ryan says, "I can stay home the rest of the day... "

"Maybe... but not until I know he's really okay and- "

"I'm hungry," interrupts a small voice coming from the stairs. Evan is awake and ready for breakfast. Ryan gets her a bowl of cereal. After eating she joins her brother in the living room, settling in on a chair next to the couch.

At 9:45, I leave a message for my boss bringing him up to date on what's happening, telling him that Joseph is feeling better and that I might be able to make it to the 11:15 session -- unless something changes between now and then.

And it does.

15 minutes later, when I check Joseph again, his blood sugar is 287 -- ketones are back up to 2.2.

The whole time, even though we've been injecting him, Joseph has been connected to his insulin pump. I'd hoped the basal insulin he was getting from it might help...

"Bud, can you pull out your set?"

He reaches down to his left hip, takes hold of the set and pulls.

Then we both just stare at the cannula: a tiny teflon tube, bent so flat it's flush with the surrounding adhesive tape.

Two. Two bent cannulas.

"I should have had you do that earlier. I just assumed... a new set... "

When I leave the room to get a new infusion set, I stand alone in the kitchen. Frozen. Thinking about this stupid mistake and what might happen because of it.

Then I grab a set.

After insertion, I give him yet another injection.

An hour later, at 11am, Joseph's blood sugar is down to 264.

But ketones are 2.5 and he's throwing up again.

"Bud, how do you feel?" I ask him, when he resettles on the couch.

"Better," he says, "actually... I feel hungry."

We both laugh. But still, I'm frightened-- and feeling more helpless than I have in a very long time.

Noon is the cut off, I tell myself.

Regardless of blood sugar, if ketones aren't improving or he throws up again, we're going to the ER.

At 11:55, I take hold of his hand.

"I'm sorry I have to keep doing this, Bud."

"It's okay, Mom." Then he gives me a long look. "Thanks for staying with me."

I look down at his hand in mine, unable to say anything. Then, praying silently, I prick the tip of his finger, touch it to the loaded strip and stare at the meter's display.

.9

And it's like a mass has suddenly been lifted from my chest.

"Yesss!" we both say, high fiving and fist bumping.

Blood sugar is still high at 244, but thankfully, it too is coming down.

"Mom, if my ketones keep going down, can we get Subway for lunch?"

"Whatever you want, Bud... whatever the heck you want."

Then I sit with him on the couch, his head in my lap, and watch reruns of the Cosby show, during which his ketone levels fall from .9 to .7 to .4 -- and finally, to zero.

(Though it takes until eight o'clock that night to bring his blood sugar down to 115 -- and far longer for me to feel in any way relaxed.)

Oh, and yes-- we did indeed get Subway for lunch.

Some of what you've missed

The kids are on spring break this week.

And sadly, all of Joseph's friends are out of town, making for a somewhat quiet few days.

To remedy this situation, we're heading out tomorrow for an impromptu visit to Chicago. Three days of traipsing around our old neighborhood, of taking in some sights... Millennium Park, the Art Institute, the Lincoln Park Zoo. Oh yes, and eating awesome Thai food, maybe some sushi.

It's gonna be great.

Now, while I'm here... I realize my posting has fallen way the heck off. And I'm sorry.

Really.

I can't make any promises, but if you're still out there reading, I will try to post more often.

In the meantime, a few short updates:

The shoulder is better -- much better. Not a hundred percent, but I made about 20 "backboard shots" playing one-on-one with Joseph on our driveway yesterday.

So, yeah.

The job has been crazy, but still pretty great.

Parenting a teenager has been a learning experience for us all. Sometimes it feels like I'm parenting two teenagers, Evan is just that savvy.

And then there's the diabetes.

Still there, still throwing us curves every once in a while. But (thankfully) nothing like it did this past fall.

Joseph continues to take ownership of more and more of his diabetes management. Last night, for example, when he finished eating a big plate of pesto pasta, he got up and cleared his plate while Ryan, Evan and I were all still eating. I turned to remind him to bolus, but before the words got out of my mouth, I saw him leaning over the kitchen counter, diabetes supplies laid out in front of him.

"What are you doing, Bud?"

"Oh, it's a set change day... I'm just gonna put in a new set before I bolus."

"Good thinking, Bud-- nice job."

"Mom, I'm getting pretty good at this stuff, you know."

"Yes, you are," I said. "And I'm getting pretty good at sitting on my hands."

At that, his head came right up-- and then, flashing me that wonderful grin of his:

"Yes-- yes, you are."

To fill in still more gaps, I thought I'd share some images/a bit of video footage from this fall and winter -- for example, giving you all a glimpse of what the kids wore on Halloween, a peek at some night sledding on this year's backyard hill, my fabulous makeover... and really, just how much the kids have grown over the last six months.

Enjoy!

In which we frighten one of Joseph's friends

"Mom, Liam doesn't think you like him."

"Bud, why would he think that? I don't even know him."

"Remember when you met him at the high school orientation night, when I was kidding with him and said, 'Dude, my mom doesn't like you'... well I think that's why."

Then Joseph's eyes take on a slightly evil glint. "Hey, I have an idea... since Liam's coming over after school tomorrow, why don't you act like you really don't like him? It'll be funny."

"I don't know, Bud... "

"C'mon, Mom-- it'll be funny."

So the next day, I'm heading up our block on the way to get Evan after school when I spot Joseph and Liam walking toward me.

"Hey Bud," I say, then turning to his friend, "Hello-- Liam," I spit out, before turning my head quickly away -- like I just smelled something really bad.

When I turn back toward the boys, Liam's blue eyes are huge; his face, drawn up in fear.

"Liam, hey.... I was just kidding."

Even though his expression melts into one full of relief, I immediately regret our little prank.

"Mom, don't worry," Joseph says, noting my concern, "I told him you were gonna do that when we saw you coming-- but you were really convincing. That was great!"

So we all have a good laugh before going our separate ways.

Fast forward to one week later -- the morning after Liam has his first sleepover at our house.

I come downstairs to the smell of fresh coffee, orange pancakes and bacon. Ryan is standing in the middle of the kitchen, spatula in hand, yuckin' it up with Joseph and Liam as both boys sit at the counter, ready for another round of pancakes.

"So Liam, how did you sleep?"

He looks up at me as if at a loss for words.

Then they all start laughing.

"What? What?"

"Okay, so I go in to check the boy last night," Ryan begins, "and remember how he sat up a few nights ago when I was checking him-- he wasn't awake, but he kept pulling away like he didn't know what I was doing?"

"Oh no," I say.

He smiles and continues.

"Well, last night I reach up to the top bunk, take Joseph's hand-- and he pulls it away. I try again, and he says, 'please... please... stop!' I finally grab hold of it a third time and tell him, 'Mister, I have to check you.' That's when he sits up and I see his face."

"It was Liam," I say.

Absolutely horrified.

Quickly I look down at the boys and (thank god) they're both laughing.

"Oh, Ryan-- how could you make that mistake?"

"I know," he says, shaking his head, "I just forgot the boy was in the bottom bunk."

Later, I ask Joseph if his friend was really okay.

"Mom, he's fine."

"And how do you feel? I mean, do you feel bad or embarrassed about what happened?"

"No, Mom. Not at all. Actually it gave us a funny story to tell... believe me, it's all good."

I'm glad they found it funny. But still, what Liam must have thought when Ryan came at him with that lancet...

Spring Thaw

Wow... three months. I can't believe it's been that long.

Well, we're still here -- and it looks like we've made it through yet another Wisconsin winter. The sun is shining, it's 60 degrees, and (Hallelujah!) I can move my arm again -- still limited, but way, way better than when I last posted to the blog.

Look how high I can reach with that arm... Hurray!

This, despite one major setback in early January.

When my insurance company decided that because I wasn't making "significant progress" with each and every visit to physical therapy, these visits now fell under the category of "maintenance" -- and as such, would no longer be covered by our plan.

No. Way.

So this is what went down: I called my case manager, and within two minutes discovered she was clueless about adhesive capsulitis (aka "frozen shoulder"). I'd barely hung up the phone when I was back on with my orthopedic specialist and PT.

Both wrote letters educating her about the condition; explaining that progress is slow and physical therapy, crucial.

And then I waited.

Four weeks.

During which time I experienced much regression (i.e., more pain, less motion).

Until finally, I called my case manager yet again:

"Have you received the letters from my doctor and physical therapist?" I ask her.

"No, I don't believe we've received any letters... but let me take a look."

"Wait a minute-- these were sent over three weeks ago."

The sound of paper shuffling on the other end.

"Oh yes, here they are.... hmmm... we'll have to review these and get back to you."

"Get back to me!? It's been FOUR WEEKS! And this thing is getting worse-- again! I'm back to waking up every night in pain... "

And then I just lose it.

"... I can't reach my back pocket! I can barely dress myself... this is INSANE! I've had this thing since early fall, finally get the right diagnosis, finally start making progress... and now because of some arbitrary decision -- a decision my DOCTOR does NOT agree with -- I'm back to where I was in November." I pause, tears now streaming into the receiver.

Silence. No response.

So I continue.

"What is your FULL name? I want to know exactly who is responsible for this decision."

"I-I... well... um... I will walk your file down for review right now," the case manager says. "I'll write 'priority' on it."

And then she pauses for maybe a second before saying, "I'm so sorry."

The next morning I get a call from my PT.

"Sandra, your insurance company just faxed approval for another 12 visits. We're back in business!"

So there you have it.

Six weeks later, I'm still doing my exercises, still going to PT-- which continues to be ridiculously painful (but I get back a little range of motion with each visit, so it's unbelievably worth it), and according to my doc, I am now in the third and final stage of this thing-- the thawing phase.

Hurray, indeed.

Frozen

"Do you have diabetes?"

"Wha - What? No, no I don't" I say, looking up at the doctor's face— trying to breathe through the pain.

"Now, lie still and try to relax your arm," he says, taking hold of my right hand once again — then lifting my arm straight up toward the ceiling.

And again I try to breathe, as this time the doc moves my arm slowly back toward my head.

Only he can't get it anywhere near my head.

Like there's some large invisible wedge between my arm and the exam table.

"Well, this is a classic case," he says, bringing my arm back down by my side and then turning to the resident sitting in a chair next to the exam table — a young dark-haired woman wearing large white-framed eyeglasses. "No history of trauma, several months of rapid loss of motion... let's turn the arm inward."

Taking hold of my wrist and elbow, he bends my arm at a right angle and attempts to twist it down toward my stomach.

I cry out— because that tiny motion feels like he's just stabbed the top and front of my shoulder with a knife.

Breathe... breathe...

"Range of motion is lost in all directions," he says, with a note of finality that makes me queasy.

Placing my arm by my side, he turns once again to the resident. They continue talking about my symptoms, my history— while I stare at the ceiling, tears sliding down into my hair.

No, it's not just what they're saying, it's the damn pain still reverberating from the top of my shoulder down to my elbow.

Please just stop.

"... so we have a severe loss of motion in all directions, high level of pain... we're dealing with only one of two things, aren't we?"

"Yes," the resident responds tentatively.

"And what tests would you order?"

"X-ray."

"Yes— which was already done, showing healthy bones with some calcification on an otherwise healthy rotator cuff, meaning we can rule out... what?

"Arthritis," the resident says, sounding more confident.

"Correct. So what is the only other thing this could be?

"Adhesive capsulitis."

"Exactly!"

They smile at each other, clearly pleased that this resident gave the right answer.

I clear my throat.

Both turn toward me.

"Yes," the doc begins, "I'm very sorry, but what you have is adhesive capsulitis — a "frozen shoulder." It's a painful condition- "

"Yes, I know."

"... one with a very long recovery period. First, understand that you didn't do anything wrong. There's nothing you could have done to stop this. No one is really sure why this happens or how. We do believe that there is an autoimmune component to it— partly because the majority of those who suffer from the condition have diabetes."

"My son has type 1 diabetes," I say, distractedly, pulling myself up so that I'm seated on the table, legs dangling over the edge like a little kid's.

The doctor tells me I'll need physical therapy for as long as a year or more. He tells me about the three stages — "freezing, frozen and thawing" — and that to minimize range of motion and muscle loss, I'll need to do a lot of work. A lot of painful work.

"What about a cortisone shot?" I ask, hopefully.

"A steroid shot won't cure this, and we see mixed results when using it to treat frozen shoulder symptoms, but it might relieve some of the pain for a short time."

"Could you give me a ball park percentage of people who present like me and actually experience pain relief from the shot?"

"I'd say it's about 50%."

"Oh."

"It's always something we can try," he tells me, "if the pain becomes unbearable."

Three hours ago, when I arrived for my appointment with this specialist — this orthopedist who deals only with shoulders — I'd been so ready to plead for a steroid shot...

But now.

"Well, it's pretty bad at night and if I challenge it in any way..." my voice fades and then, "I think I'll hold off on the shot today."

So that's it.

I've heard about this thing, but could never really appreciate how bad it was until now.

Until I couldn't go to bed without waking repeatedly in crushing pain, simply because I rolled onto my shoulder.

Until I couldn't get my coat off without a struggle.

Until I couldn't reach my back pocket.

Until there was no sledding.

(Not even on the backyard hill)

No hugging my children without pain...

I don't think I've stopped shaking since yesterday's appointment.

Growing Pain

Over the last four years I've received messages from readers telling me how we're doing a "beautiful job" helping Joseph manage his diabetes and that I'm an "amazing" mom.

Well at the beginning of last month, I felt about as far from amazing as any mom could get — and even now, I'm still a little shaky.

You see, Joseph was sneaking food, treats mostly — but worse, he wasn't bolusing for them.

When I first found out that he wasn't being truthful with us, it hurt.

A lot.

But the not bolusing, well that just froze me in my tracks.

For several days and nights after I realized what was going on, I couldn't think of anything but what this might do to him in the long run — not just the effects of the high blood sugars, but the habit he seemed to be falling into.

And desperately, I wondered why?

We'd always worked together on this stuff, but now...

It started with small things, a candy wrapper in his room, a number of unexpected high blood sugars... coming to a head just after Halloween — when we left a bright red plastic bag filled with nearly 4 lbs of candy sitting on our kitchen counter.

(Stupid to have left this out, I know.)

Within a few days the bag weighed considerably less.

I discovered this after yet another argument with Joseph about him having eaten a snack without bolusing — this time, a chocolate chip granola bar.

His blood sugar was 404.

I asked him why he hadn't bolused.

"I don't know," he said turning away from me.

I got upset, choking out that I didn't want him to hurt himself. That if he gets in the habit of eating without insulin, he could set himself up for other health problems — serious health problems...

And when it seemed like he was tuning me out, "... some people have lost their sight because they ignored their diabetes, because they didn't take care of themselves."

Immediately, I wanted to take it back.

"Wait, Bud- "

But he was already halfway up the stairs, heading to his room.

Shaken, I returned to the kitchen to start making dinner. To calm down. That's when I noticed that red bag on the counter next to the stove, and — looking at it closely for the first time in a few days — saw the empty wrappers sticking out of the top of it. I opened it wider, and there were piles of them.

Oh no.

"Joseph," I called up the stairs, "was that granola bar the only thing you ate?"

No answer.

"Joseph— please, come downstairs."

A moment later he walked slowly into the kitchen wearing an inscrutable expression, then his eyes traveled to the red bag on the counter.

"No, I had a mini Snickers too."

"But why, Bud? It can't feel good to be high... if you eat something, please, you have to bolus for it."

"Yeah, I know." That's all he said.

The next afternoon, when he arrived home from school, I asked Joseph to sit down with me on the couch in our lower level. To talk.

"What's really going on, Bud?"

"I don't know... it's just hard having diabetes... I mean, no one else has to think about this stuff, they just eat what they want when they want. You know what B told me on the phone last night? He has his Halloween bag under his bed, his parents have no idea it's there... "

"But Honey- "

" ... and when I see your face when I have a high blood sugar, I just feel bad."

"Bud, I- I'm sorry. I don't know what to say... If I look upset when you're high, it's not you... I'm not angry or disappointed in you, I'm just worried about the high. I'm sorry that I made you feel like that. No matter what we do, there are always gonna be highs, lows — we can't make this perfect. Nothing is perfect."

"I know, I just hate having this," he said, his voice catching — and then he looked down at his hands for a few seconds before going on, "and please Mom, please don't say I'm gonna go blind."

Looking up at me, eyes wet with tears, he suddenly looked very young.

I put my arms around him— my own tears dripping down onto his shoulder as I held him close.

"I'm sorry, Bud — that was a horrible thing to say. I was so desperate to get through to you. I don't want to scare you, I just want you to take care of yourself. Listen, we are going to figure this out, I promise."

For a moment, we just sat there and said nothing.

Finally, we both stood up. "Hey, I'm hungry," he said. Then, without missing a beat, he pulled out his meter and pricked a heavily calloused finger.

"189... I can wait until dinner."

"No, Bud - go eat something now if you're hungry, just bolus for it."

"Okay," he said, "I'll have a banana," and he ran up the stairs taking two at a time.

Later, with the rich smell of ratatouille filling the kitchen, I called upstairs to the kids, telling them dinner will be ready soon, giving them the 10-minute warning. Evan clomped heavily down the stairs, shuffled into the kitchen and grudgingly agreed to try the ratatouille, but insisted that she "hates" polenta.

Shaking my head, I handed her some utensils to put on the table.

"Bud, can you do a check?" I said to Joseph, while pulling four white plates out of the cupboard.

He's 249.

"Hey, did you bolus for that banana?"

"Yes," he said, "two units." Then he filled several glasses with lime fizzy water, placed them on the table, and headed back up to his room.

A few minutes later, while standing next to Ryan at the stove, I noticed something on the floor in a corner of the kitchen— a large, empty, silver can.

And immediately I knew. Because Ryan's mom had called me earlier that day to ask if she should bring more cookies when she comes down in a couple of weeks. I'd checked that can and told her "yes" — because there was one cookie left.

I walked upstairs, knocked on Joseph's bedroom door and just asked him.

"Yeah, I had one," he said without looking up.

"When you had the banana?"

"Yeah."

"And you didn't bolus for it."

"No, I didn't," he said quietly.

"But, why?" I asked, desperate for an answer.

"Because I knew you wouldn't want me to have one. That you'd rather I made a healthy choice."

"Bud, even if you didn't have diabetes, I'd encourage you to eat healthy — that's what Mom's do — it's the not bolusing that really scares me."

Then I turned around, and walked back down the stairs, a massive lump sticking at the back of my throat.

I don't understand — he can have treats . . . when we have dessert, he has dessert; when he wants to go get ice cream with his friends, I let him...

His last A1c was 8.7

It's been creeping up again, thanks to many unexplained highs— highs I thought were due to the hormones of a growing teen (and maybe that's at least partly true), but now I don't know.

Joseph and I have always been able to talk about things, about almost anything, really. But lately, we've been arguing a ton.

I don't know what to do.

********************************************************

I wrote much of this post about three weeks ago — since then, I've done a good deal of crying and a lot of thinking. I've also gone online and — among other things — read this thread on tudiabetes.org. I discovered that what we've been going through is fairly common.

Just knowing we weren't alone gave me strength — and made me believe that we could get through this.

It took a lot more talking — and far more listening — before it finally hit me:

Joseph's sneaking food and not bolusing for it may have had less to do with deprivation than it did with him needing more independence.

(Yes, I realize to some this may sound counterintuitive, but hear me out.)

I honestly believe that by making choices he knew I wouldn't like, by not bolusing, he was struggling with us — with me — to "take the wheel." To show us that if we continue to drive this thing and not trust him to do it, we are going to crash.

He's going to crash.

(Does this make any sense?)

Joseph knows more about nutrition than most people and eats healthy food at home; he knows how to count carbs and how to bolus for food better than we do.

He has a good foundation.

Now, while we've let him eat like a kid and, more recently, like a teenager, he's always asked or sent a text to one of us when he's going to eat a snack, with carbs and a bolus calculation — and for a long while now, 99.9% of the time we text or say "go for it."

And I think it's that routine that needed to change.

Sooo...

Two weeks ago, I went up to his room, sat down next to him on the edge of his bed and took a deep breath.

"Bud, how would you feel about eating snacks and not calling or texting me about them? About coming home from school and getting something out of the pantry without checking with me or Dad first?

Still checking your blood sugar and bolusing, but not checking with us?"

His face lights up.

"Really?"

"Yes, really. Bud, I've been stupid. I should have done this a long time ago. You know, when I was your age I used to eat these things called "Hot Fries"... Andy Capp's Hot Fries. Never asked my mom, I just walked down to Prevites Market, bought a bag and ate them. And I loved Nestle Crunch bars, too. Now don't get me wrong," I add quickly, "I didn't sit down and eat masses of them, but I ate treats when I was a teenager. And I didn't ask for anyone's permission to do it... I want you to be able to do that too."

I'm about to say more, but I can't — because Joseph has me in a bear hug.

"Mom, I love you," he says, holding me tight, "and I'm sorry about not bolusing. I'm really, really sorry."

Then he pulls away from me, suddenly looking much older.

"I can do this, Mom."

And for the first time in weeks, I feel like I've done the right thing.