Glucagon Mini-Dosing | Caleb’s Recap #vlog

Our friend Bill from 1HappyDiabetic.com is hosting the “Pay It Forward Program”. Bill is a diabetes video master. He, in conjunction with wellthen.org has created this program to get video cameras to people who might not otherwise have access to one. If you’ve always wanted to create a diabetes related video, but couldn’t get your hands on the proper equipment, now’s your chance to let your creative ideas and energies flow. See Bill’s site for more info on the program.

Because we love all things Bill, Caleb signed up for the program, we received one of Bill’s Mino HD Flip cameras and we went to work. After considering a few ideas, Caleb felt the story of his mini-glucagon experience was an important one to share.

You may have read my version of events yesterday. Here is Caleb’s recap. However, I warn you, this may not be appropriate viewing if you are the slightest bit squeamish. This video was created by Caleb, a seven year-old boy with a typical seven year-old boy’s sense of humor. Please keep that in mind should you dare to proceed.

I decided not to discourage Caleb’s creativity as he was particularly enthusiastic about his ideas. I apologize in advance. ūüôā

Glucagon Mini-Dosing | A Valuable Tool

Breakfast with Santa is something we all look forward to each year. It is simply magical to see any doubt my kids may have instantly vanish when Santa and Mrs. Claus approach them and say, “Hey, I hear you guys (insert actual fact about their lives that the Claus’ would have no way of knowing unless they were indeed real).”

Usually, Santa makes his first appearance after we are settled and have begun eating. He wanders around the room and makes small talk with everyone. After a little while, he and Mrs. Claus call the families up one by one and meet with them personally. ¬†This year, for the first time, Santa was there and ready to go when we walked in. ¬†We not only had a casual chat at our table, but were done with our personal time with the Claus’ before breakfast was even served.

Everyone looks happy, don’t they?

As we headed back to our seats, Caleb said his belly was bothering him. It was more than a hour after our normal breakfast time, so I attributed it to hunger. I asked him if he was ready to eat, to which he replied, “yes”, and I bolused. Pancakes were retrieved and Caleb began eating.

Caleb ate slowly and very little. He decided that the sight and smell of food was unappealing. He took a sip of juice and waved that away too.

I had just bolused him with 4 units of insulin. 4 units is about twenty percent of Caleb’s total daily dose.

I coaxed him to drink his juice – maybe the insulin was kicking in and he’s starting to feel low and a little boost will make him feel better.

It didn’t. He heaved.

At this point David and Colin had left for another commitment of Colin’s. Lila was distracted with various Christmas crafts.

I quickly swept Caleb away to the bathroom and anything he had just ingested came back out like a fire hose.

“No need to panic”, I told myself.

Caleb felt better after getting all that up. Maybe this was just a one time thing and he would have his appetite back.

No such luck. He threw up 2 more times over the course of the next half hour.

I knew the urgency of the situation. I knew I might need to get him to the hospital for a glucose drip and intravenous hydration. Still, there was no panic. I had the benefit of knowing a course of action that could avoid a trip to the emergency room.

Mini-glucagon.

I distinctly remember the details of Nan’s story in a similar situation. I remember how alarmed I felt when I read it the first time, picturing her and C going through every single step. The thought of using glucagon in mini doses that way was a new idea to me. I only had the frame of reference we were given when Caleb was diagnosed:

  • Use glucagon in an emergency only.
  • Use glucagon if Caleb has a severe hypoglycemic episode and can’t eat anything.
  • Try squeezing glucose gel in his cheek first.
  • Use glucagon if he’s unconscious and nothing else works.
  • Use it as a last resort.
  • We hope you never have to use it.

But thanks to Nan’s story, I knew that glucagon could be used in a less severe, though equally urgent situation. I pulled it out and put it on the table. I explained to Caleb that if he couldn’t eat, I would be able to cover the bolus with a shot. After a few more attempts to drink, he looked at me and said, “Mom, let’s do the shot.”

So that’s what we did. He pulled up his sleeve and I injected him with 5 units. Almost instantly, he looked better. He was soon feeling better and able to do a craft with his sister.

After a little while, a fingerstick of 89, and quite a bit of insulin still working in him, I gave him another injection of 5 units.

We finished everything we needed to and Caleb seemed to be at a safe blood sugar for transport. So we made our move. ¬†If anyone around us had a clue what was going on, they didn’t make it known.

We got home and I tucked Caleb into bed and made him comfortable. He was a safe 134 and we were out of the danger zone.  He was able to keep down enough fluids to stay hydrated and his blood sugar remained stable.

Thank you to my friends who have shared their¬†own glucagon stories and thus given me the confidence and composure to handle this. Without the benefit of¬†your combined stories, I’m certain things would have gone very differently.

I thought I would never want to be part of the “Glucagon¬†Club” but in fact I am glad to be in it. Given the circumstances of that morning, mini glucagon seems like an easy fix compared to any other alternatives I can think of.

Lastly, and maybe most importantly, thank you Santa for being early this year.  Someone was watching over us to make sure that we could have that moment of joy. Our memory of that morning is mostly of our meeting with Mr. and Mrs. Claus which just happened to be followed by an unfortunate series of events. Had we eaten breakfast first like we normally do, those pictures above would be at least one person shy.

For more information on glucagon, here are the resources and stories that prepared me:

Note: the recommended dosing for mini glucagon is as follows:

  • ages 2 years and under:¬†2 units
  • age 2 to 15 years:¬†1 unit ¬†for each year of age (6 units for a 6 year old, etc.)
  • age 15 years and older:¬†15 units

I used a standard insulin syringe (not the harpoon included in the kit).

Caleb’s recap of these events is here.

Thank you for the nomination!

I posted on Facebook and Twitter on Friday, but since I don’t know who did the nominating, I want to extend my reach to hopefully get my thanks to the proper party.

I was surprised to get a message last week that I had been nominated for a DOC Award.

Saying that the Diabetes Online Community has made me feel good sums things up nicely. Whether it’s a little event on a particular day, or the cumulative effect of having connected with and learned so much from so many, I feel better about diabetes. Without you I would wonder and worry exponentially more than I do. Your support gives me the calmness and confidence to work with Caleb to manage his diabetes every day such that it doesn’t consume us.

To be nominated amongst four other bloggers in the category, “Most Likely to Put You in a Good Mood” surprised and touched me. I am happy to know that I have been able to give back, even if just a little, what I have received from this community a thousand times over.

So thank you to whomever thought of me when making your nominations. You put me in a great mood!

Harry Potter – the Ultimate Remedy? | Podcast

Not that you have an hour to spare, or if you did you would spend it listening to me, but should you be so inclined, I invite you to listen to me talk with Chris on “Just Talking”. He has devoted the month of November to all diabetes Podcasts and he and I kicked it off couple of weeks ago. Since then he’s also talked with Nikki Lang and the combined talents of Ginger, Manny and Dayle.

Chris blogs at A Consequence of Hypoglycemia and is¬†a wonderful Podcast host. I’ve enjoyed listening to several of his interviews while getting to know so many of the DOC a little better. ¬†If only I let him talk a little more, Podcast 55 might be a little more entertaining. ūüôā

I think Chris did a fantastic job with the questions he asked and I thank him for taking the time to include me in his line-up.  I had a complete blast!

Much of the conversation is about Caleb, parenting a child with diabetes and the power of the DOC, but we also touch upon the Yankees, my accent (who me – an accent?), some of our heros and how Harry Potter can help get you through what could otherwise be a very tough time. ¬†My apologies in advance for all my babbling and “umms” and such.

PS: Harry Potter 7, Part 1 releases in movie theaters TODAY!!!!  Woohoo!!!!

Setting the Record Straight | Type 1 Diabetes in School

I found this video very powerful.

Thank you Adjoa for sharing it. ¬†Not only does it articulate the facts about type 1 diabetes clearly and succinctly, it addresses a very important issue to children with diabetes – bullying. ¬†Personally, we have yet to experience anything remotely like this, but perhaps that’s because Caleb is younger. I’m doing what I can to educate the people around Caleb in hopes to pre-empt it. ¬†Time will tell if I’m successful.

I Introduce the Man Behind the Curtain | Don’t Fear Diabetes

Chris of "Don't Fear Diabetes"

It is my great pleasure to introduce you to the writer of¬†Don’t Fear Diabetes. ¬†To date you may know him as Sisiay. Even without knowing his real name, I was drawn to him because of his balanced and positive attitude. I’ve enjoyed exchanging tips with him regarding DexCom and other tools, though I was sorry that the rice trick didn’t work on his ocean drenched receiver. ¬†I admire his outlook on healthy eating, his ingenuity and his photography. Enough from me though, let’s hear from him…

Welcome to my coming out party!

Well, not exactly, but this is a moment that I’ve been thinking about/planning for a long time, which, in a way, is sort of ridiculous, since the whole thrust of this post is going to be explaining why this isn’t and shouldn’t be a big deal.

Anyway, that said, here I go:  My name is Christopher Angell, and I am a diabetic.

Wow.  That wasn’t so bad.

For the past several months, I have been blogging and participating in other various online diabetes activities using the screen name sisiay.  Sisiay is just a phonetic spelling of my initials, CCA.  But starting now, I’m going to be using my real name for all my [diabetes-related] online activity.  And hopefully I won’t confuse too many people (or search engines) in the process.

So why did I start my online diabetic life anonymously, and why am I using my real name now?  Well, funny you should ask.  That’s exactly what I was planning on telling you anyway.

When I first set up my blog, it never occurred to me to write anonymously, and my very first post was under my real name.  But after I wrote that post, and was browsing through my RSS feed of other diabetes blogs, and I came upon this post at six until me about disclosure.  And for some reason I freaked out and quickly went back and changed all of my profiles to a pseudonym.  I don’t really know what I was worried about.  I don’t try to hide my diabetes from anybody in my life (friends, family, insurers, airport security, that guy on the street who’s looking at my Dexcom funny, etc) so why was it important for me to hide it from strangers?  And not just strangers, but strangers I was interacting with specifically to discuss diabetes?

I think the answer is that at the time, it was far easier to imagine negative consequences from using my real name than it was to imagine negative consequences from not using my real name.  Would my insurance company read a post and decide something I did was grounds for terminating my policy?  Would I someday be applying for a job and the HR manager would decide that it wasn’t worth the risk/expense of hiring a diabetic?  Would I write something seemingly innocuous that would end up angering a former Special Forces assassin who would make it his life’s mission to track me down and torture me by forcing me to eat an entire package of Peeps from each of their 64 different holiday collections? It was hard to imagine something equally unpleasant (or improbable) resulting from anonymity.

But the more time I spent in the diabetic online community, the more I regretted my decision not to identify myself by my real name.   One of the things you don’t realize until you really spend a lot of time reading patient/advocate blogs is that what someone says is only a small part of the value of their writings.  How they present it, and how it ties into the larger framework of their life determines, to a very large extent, how you respond to individual comments/observations/advice/rants/etc.  I began to notice that all of the people whom I trusted/followed the most were people who were fully disclosed.  And I began to realize that it had a lot more to do with what they shared about their lives apart from diabetes than it did with their more clinical observations.

That, in turn, made me realize that writing anonymously made sharing information about my life outside my diabetes tips and experiences pointless, because personal anecdotes are only interesting when they come from a person, and I had made myself a character, a one-dimensional faceless voice.

And that’s not what I want to be anymore!  So, I’m moving into the open.  I’m going to talk a little bit more about life and work and travel.  But still, mostly about diabetes and things I do to make living with it better (and the things it does to me to make living better…and sometimes worse).  I hope no assassins take that the wrong way.

It’s nice to “meet” you Chris! You have always been one of the people whom I most trust and respect. ¬†But as I can see your point above, I greatly anticipate what you have to share now that you are completely out in the open. I’m keeping a close eye out for that next post. After seeing your photo – which completely made me smile – I couldn’t resist but share this one of Caleb who has always been a sunglasses kind of guy:

Talking with Dr. Francine Kaufman about STAR 3

You may have heard the announcement of the results of the STAR 3 study last week. Amy of Diabetes Mine had a hot-off-the-press post about it here.

I had the opportunity to speak with Dr. Francine Kaufman of Medtronic about this study on behalf of TuDiabetes.  Please visit me there to read what she had to say.

To me this study validates what many of us already believe Рthat the use of sensor-augmented pump therapy leads to improved blood glucose control.  I hope the claim that this will become the standard of care is realized and the troubles that people continue to have getting insurance coverage for these devices becomes a thing of the past.

I also hope that this momentum will continue to bring us within real reach of that artifical pancreas so many parents (me included) are hoping for our kids before they head off to college.  Should it come sooner, even better!

Power of Perspective | Guest Blog on The Life of a Diabetic

Chris Stocker is having guest bloggers on The Life of a Diabetic this week.  He asked me if I would be interested in writing about parenting a child with diabetes. Sure! Why not? Thanks for considering me, Chris!

I enjoy Chris’ blog because it is honest and straightforward.¬† He gets to the heart of the issue quickly and directly. ¬†If you don’t already follow Chris, check him out. ¬†I think you’ll like his candor.

There is a specific complexity to raising a child with diabetes for a parent that does not have diabetes him or herself.¬† Even though much of Caleb’s life is different than mine when I grew up, with the exception of diabetes, I have my own experiences to draw upon to help me care for and guide him.¬† Because I don’t have any former knowledge of diabetes, there is a large element of Caleb’s future that is foreign to me.¬† Parenting is chockful of worries.¬† The uncertainty of what D holds for your child adds to that worry heavily.

So with that introduction, I ask that you visit me over at The Life of a Diabetic to read my thoughts about connecting with adults who live with diabetes.¬† I’m happy to have the opportunity to express my thanks to all those who help me, on the blog of one of those very people.

Our Happy DexCom Friends – video trifecta

As we began our CGM adventure with much trepidation, we were embraced, truly embraced, by our friends Bill and Suzanne.

I think the first time I “met” Bill was when he commented on Caleb’s low video and dubbed him a “Diabetic Ninja“. ¬†Shortly thereafter he named Caleb “Diabetic of the Day”¬†¬†in one of his own videos. Bill was one of the first people who found us through Caleb’s face on YouTube. ¬†I remember how Caleb smiled when he saw that he was in Bill’s video. ¬†As I’m sure was intended, it made him happy.

We have kept in touch with Bill and he and Caleb even have a friendly rivalry over their favorite baseball teams – Bill’s Red Sox v. Caleb’s Yankees.

Through Bill, we met Suzanne. ¬†Suzanne and I tweeted a great deal about DexCom. She answered my unending questions and understood my apprehensions about putting Caleb through another skin piercing process. ¬†She knew of Caleb and Bill’s relationship and asked if a video from Bill might help us prepare for our training. ¬†Of course the answer was, “yes”.

So Bill and Caleb made a deal to make videos for each other. ¬†Here’s Bill’s:

Suzanne also joined in the video encouragement:

To which Caleb responded:

Bill and Suzanne helped us so much through our CGM transition.  They went out of their way to make these videos for Caleb and sent us many heartfelt emails and tweets.  Thank you my happy diabetic friends!

“It’s all about your attitude!” Yours are fantastic, influential and even contagious!!

D Tweeps to the rescue!

On the way to the game
On the way to the game

This is a shout out to my friends on Twitter.

Yesterday, we went to an MLB game. MLB stadium means stadium food. Stadium food means unknown carbs and usually not the best food which typically means out of range BGs and stress and anxiety.

Yesterday was different. ¬†We got to the stadium at lunch time and decided to eat. Caleb ordered up a hotdog and the kid’s special came with Kozy Shack pudding – I could handle that. ¬†We’ve done hot dogs often enough and I did a Calorie King search on my phone for the pudding: up to 44 carbs. ¬†Then Caleb’s brother asked for a pretzel – one of the enormous, soft, stadium pretzels. ¬†We got a couple to share. ¬†Okay I could do this. ¬†I did a Google search and a Calorie King search and the results were mixed. ¬†I saw anything from 45 to 101 carbs. ¬†Hmmm. ¬†How do I decide?

Normally in this circumstance I begin to tense. ¬†I am typically surrounded by three children with various questions and needs and all vocalizing them simultaneously. ¬†Any adults present, although aware of the extra work D takes, do not truly appreciate the implications that eating unknown carbs of unusual foods have. ¬†I am alone with this responsibility. ¬†I need to think and think quickly while trying to meet the various other needs of, “I’m hot”, “When will the game start?” “Can I have ketchup with that?” ¬†“Did you see the train pass by?” “Look there’s Jeter!” ¬†You get the picture.

Well yesterday I had a different approach. ¬†I tweeted, “How many carbs in a stadium pretzel?” ¬†Here are some of the responses I received within minutes:IMG_0665

The results were similar to what I had already found from my own searches.  The difference was that I did not feel isolated.  I had people surrounding me who understood.  People who wanted to help.  People who validated what a was considering.  I literally felt like they were there beside me, whispering in my ear, giving me advice and support to make this decision.  I was not alone.

So I took the information and made a decision with the help of my Tweeps, bolused Caleb and we all ate.  I was not stressed and tensed.  I did not feel this big weight on my shoulders wondering if I had made the right decision.  I had input from others.  We did this together.

Yankee Stadium July 18, 2009
Yankee Stadium July 18, 2009

The good news is, Caleb’s BGs were great. ¬†This was the first time an outing was not a disaster of lows or highs or both. ¬†There was no gray cloud of D casting its shadow on our fun. ¬†Although I think part of that is attributable to the alignment of the planets, I know it also had to do with me being able to make good carb decisions. ¬†Caleb felt good, I felt good. ¬†It was indeed a victory.

So thank you Tweeps for being there with me yesterday.  You helped make the day more enjoyable.

Oh and A-Rod hit a homer, Jeter made a great play to first and Mo did what Mo does best and the Yankees had a victory too.  It was a great outing all around!