Friday, April 08, 2005

Counting Carbs, Counting Sheep

Diabetes has it's ups and downs. That's a fact. With each high blood sugar come thoughts of future complications, and with the lows there is the urgent need to act-- not to mention the fear that too many lows will result in the dulled awareness of a blood sugar drop.

Okay this is what comes of starting a blog after a long string of sleepless nights. Doom and gloom. Nighttime blood sugar checks and a teething two-year old are a deadly combination. Under these circumstances diabetes management becomes diabetes overload real fast. I try to make it look easy to Joseph. I tell him "we're getting there. It's just gonna take some time to get this pump thing down. Remember how it was adjusting to shots?" I don't want him to fear the future when he will have to manage this himself.

And we really have made a ton of progress in all of this.

For example:

One month after diagnosis we got Joseph off of NPH and on Lantus. This was HUGE. While taking NPH, Joseph had to eat the same number of carbs at the same time every day. He had to eat a morning, afternoon and bedtime snack-- hungry or not. In other words, we had to feed the insulin in order to prevent the lows. NPH has a rather nasty peak in insulin action. For one month we were slaves to it. And Joseph absolutely hated the regimen. But the alternative, Lantus, required that he get a shot at school. He wasn't ready for that. It was all so new. And he was starting a new school. Riding the bus for the first time.

Things changed though. He was doing his own finger sticks in the nurse's office before lunch every day. Suddenly, the idea of getting a shot at school didn't sound so bad. Especially after I described how different his life would be while on Lantus.

All right, I need to stop right here a moment and rant about NPH. I can't help it. This is really a sore spot for me. Why in the world are newly diagnosed diabetics still being put on this insulin? After all, Lantus is FDA approved for children 6 and older (it's not approved for children under 6 because there have been no studies conducted within this group). Furthermore, I am astounded at the number of parents I've encountered with children who are STILL on NPH six months, a year, or more after diagnosis. And, most of these parents have never even heard of Lantus. Now that's just messed up. Why aren't their doctors telling them about this option? I understand that Lantus requires an extra shot, but it works so darn well as a long-acting insulin. One shot at bedtime (or in the morning) gives a very stable background insulin for 18-26 hours with virtually no peaks in the majority of people who use it.

Lantus has been called "the poor man's pump" and we quickly discovered why.

Joseph's blood sugars stabilized for the most part. Sure, there were still highs and lows, but not so many extremes. Even better, he felt free. He could eat when he wanted, sleep in on the weekends, snack or not. It was his choice.

Now at this point you might ask, "why did you put him on the pump if Lantus was working so well?" Yes, Lantus at bedtime and short-acting Novalog to cover the foods he ate worked well indeed. But we wanted more. And the syringe is such a blunt tool. I knew we could never achieve the kind of control or flexibility he could get on the pump if we stayed with his existing regimen. Joseph was (and still is) extremely insulin sensitive. And he was (and again, still is) in the honeymoon period of this disease with a total daily dose rarely more than 8 units. I'd read in several places that tight control early could actually extend the honeymoon, delaying the destruction of what little remained of his beta cells. Why do that? Because taking in less insulin is healthier. Because a cure might be found that could involve residual beta cell function. Because I wasn't -- and am still not -- ready to surrender my son completely to this disease.

So we pushed for the pump. And after several months of wrangling with the nurse practitioner at his clinic, we got it.

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