As Ryan and I enter Joseph's cabin, we're greeted with the sight of many boys talking, laughing, stuffing their clothes into duffles, and messing with funky colored balls, little electric fans, light-up necklaces, etc... All labeled with some diabetes-related sponsor's name -- camp swag.
And there is Joseph, his back to us, standing half a dozen bunks away. I watch him for a few moments-- joking around with two other campers, and checking out the trinkets he has spread on top of his bunk. I look for signs that things might not have gone well.
So far (thank God)-- nothing.
He finally turns around and sees us, runs across the room and throws his arms around me-- for a moment, we hold each other tight.
I'm trying hard not to lose it-- after all, I don't want to embarrass the kid.
He looks up at me and says, "I missed you," then walks the two of us over to his bunk and continues to pack. He looks as though he's anxious to tell us something, but for a while says nothing. He just keeps fiddling with a bright blue, purple and red ball that lights up every time he whacks it with his hand.
I watch him carefully, bracing myself. And then he lifts his head, looking from Ryan to me.
"Guess what?" he asks, with a huge grin.
"I got asked out on a date."
The boy just cannot stop smiling.
"Reeeally." I say.
"Yeah, the girl who said I was cute last year-- she asked me to the dance."
"And we danced."
"Oh Yeah," he says, nodding and smiling even bigger than I thought possible.
"And Mom, I think she's 12."
"Oh. My. God."
I breathe a sigh of relief.
"Oh, and Mom-- " he says, giving me a meaningful look, then mouthing the words through yet another smile:
"I didn't have any accidents."
"All righty then, let's get you packed."
As we pick up his clothes, and try to collect his booty (he keeps wanting to play with each thing before we put it in his bag), Joseph tells us about camp: about the paddleboat sponge fight and water dodgeball; about learning how to kayak ("it's a lot harder than it looks"); catching frogs (he caught several!); and of course, his time in the mud pit ("It was gross, Mom. It smelled really, really bad-- but it was awesome!").
Oh yes this was good for him-- very, very good.
But then, he says -- almost nonchalantly -- "And one night, I was really high-- like higher than I've ever been."
I stop packing.
"What do you mean, bud?"
"Well, I had them check me 'cause I didn't feel right and the meter said 'HI' -- and they said that meant I was like over 600!"
"But my set was bad," he says quickly, "I could tell because my cannula was sticking out."
"Did you have any ketones?" I ask, breath held.
Okay, he was fine. Just fine.
But as we continue packing, I struggle to keep a growing fear in check.
What if something awful happened again? But the 'HI' was just a bad set-- a fluke, really.
It had to be.
Just then, Joseph's very friendly and rather burly counselor comes over and says the nurse is ready for me.
Before I even sit down, she is telling me that things went very well.
"Joseph's sugars were really good this week, and he had no nighttime accidents," she says smiling brightly.
"Yes, Joseph told me-- that's wonderful. But he did mention that he'd had one very high blood sugar-- that the meter had said 'HI' -- we've never seen that before."
"Yes, we had to change his site that evening," she says, her smile beginning to fade. "Well, uh . . . let's have a look at the log."
She pulls a sheet of paper from Joseph's file, and slides it in front of me.
"Now we did several set changes-- we always like to do them when the kids have been in the mud pit, and then we had that bad set."
I'm listening to her, nodding-- while looking very carefully at the log. Those first two days were awesome. But it was on that second night that he went 'HI' and stayed that way for several hours . . .
I look at that for a long moment.
On the third night, he was 246 at bedtime-- they gave him a snack and a bolus (with a correction-- despite the fact that his combo bolus for his dinner had just finished). At midnight he was 120-- they never did the 2:30 AM check. At 10 AM, he was 367.
A rebound high.
The fourth night they'd given him a snack and over a unit of insulin at 9pm-- just three hours after a large meal bolus with a correction. There were no nighttime checks that night (though they did get him up to use the bathroom). And he was 356 by 10 AM the next morning.
The fifth and final night saw a 425 at bedtime.
"He had no ketones throughout the week," she says-- obviously noting the concern on my face as I stare at the number.
And, as my finger moves from the "Blood Glucose" box down to the "Correction Bolus" box, the nurse tells me:
"Oh, and Doctor D overrode the pump's recommended correction that night because Joseph was so high." In the bolus box I see a .5 crossed out and a full unit written over it. I also see that Joseph clearly still had insulin on board from a very large dinner bolus.
He was 96 by midnight-- having dropped 329 points in three hours. When they checked him two and a half hours later, he was 135 and climbing -- by 7am he was 254.
"I'm really thinkin' that there were several rebound highs this week-- that he may have had a number of low blood sugars that were not picked up overnight. I mean, those morning highs are kind of unusual."
"You mean from the Somogyi effect?" she asks with a look of sudden understanding.
"Yes, that's exactly what I mean."
"Well, yes . . . you might be right . . . I'm sorry. There were a couple of nights in there when he wasn't checked as often-- when I wasn't on duty, and well, they just followed the usual protocol."
"I see," I respond quietly.
About 20 minutes later, Joseph is packed and we're ready to head home. We take one last look at the lake, still and shimmering under a perfect, clear sky. Then we make our way to the parking lot-- Joseph saying goodbyes and talking the whole time about the dance, the girl who asked him to it, and how much better camp was this year than last.
Despite the things that didn't go right, it's obvious this experience meant a great deal to him. And really, it's hard not to feel good about something that so clearly makes your child happy.
But still, as we drive away I'm thinking again about those rebound highs-- the lows they imply -- and how to avoid them next year.