Friday, October 16, 2009

Finally - Carb to Insulin Ratios!

Thursday, May 7th

Shortly after I started back to work, I spoke with the Safety Director at work. Her Grandson was diagnosed with Type 1 about 5 years ago. She told me about how he had actually gone into a coma because his sugar was so high (it was well over 1,000, but I'm thinking she said it was over 2,000 and Ellee's was 668 at diagnosis). She also said that he does his shot after he eats, figuring out how many carbs he ate as opposed to making him eat a certain amount. WOW... this sounds a lot better than trying to make Ellee eat a certain amount of carbs for a meal and panicing if she didn't eat it all.

When we were at Childrens meeting with Winnie to train Mom, Dad, and Tonya, we also had to meet with Karen, a dietition. I brought up this carb to insulin ratio with her and she agreed that it would be a good thing! She left to check with one of the doctors (because she couldn't authorize it) then came back in and instructed us on how to do this new process.

Other Type 1s have been doing Carb:Insulin for a long time, and when people are on the pump, this is how they tell the pump how much insulin to give... but for us it was a new and exciting adventure! And it was! This took so much unnecessary stress out of our lives. I hate fighting with the girls about eating. I don't want to force them to eat something they don't like and I understand that they go through growth spurts where one minute they will eat like piggies and the next they won't touch an ounce of food. Through insulin on top of this and you have World War III in the Braun household! Up until this point I tried not to make too much of a fuss about Ellee not eating something and found a substitute that she would eat. We had enough other stuff to fight about, I didn't want this to be one of them.

Before, we were instructed to give her 2 units before dinner and have her eat 40 carbs. Of course the number of units may change or the number of carbs may change depending on if she was having lots of low readings. But it was the same concept, give her a shot and make her eat a certain amount. On the other hand, Carb:Insulin Ratio works like this... based on her past sugar readings, the doctor sets a ratio for her, like 1:20 (1 unit for every 20 grams of carbs). We test her sugar before she eats, then let her eat what how ever much of her dinner she wants. If she has 10 carbs, we give her half a unit, 1 unit for 20 carbs, 2 units for 40 carbs. Every so often the doctors will look to see if an adjustment needs made based on if her sugar is too high or having too many lows. It is better than sliced bread! They couldn't send us home doing this because they needed to make sure that we understand how to count the carbs, which makes sense. Still makes me wish that they would have told us about this sooner!

First Few Days Home

Friday, April 24th

Wow... now what do we do? Josh and I both work and who ever watches the girls needs to be trained on how to give her shots, check her sugar, and count carbs. At this point Dad and Tonya are watching the girls for us and taking Ellee to Preschool for the few hours that she has class. Since we were really slow at work, my boss and I agreed that I could work half days for as long as I needed to. So, our schedule for the next month was for me to get up as early as I could in the mornings and go into work and work half a day, Josh would go to work in the afternoon.


HELP IS ON ITS WAY!!!
It was such a relief when we were able to set a date for Mom and Dad to go to Columbus to meet with Winnie to get their training done. I wasn't going to push it, but Tonya wanted to get trained because she still wanted to watch the girls. I'm not going push some one into doing this because as a parent it was hard enough for me to do it, but I'll take any help I can get!

Everyone meet at the house and we headed for Columbus. Not sure why we didn't take Aunt Susie up on the offer to watch Dani, but we didn't think it would be that bad and she might as well go with us. I think we were planning on going to the Zoo afterwards, but that didn't work out.

There is nothing funner than putting 7 adults and two little kids in a very small room with lots of needles! I'll get to the details in a second, but want to say that I acutally learned something about my little brother... and it's kind of disturbing!!! Here is how this played out:

We're sitting on one side of a table and Winnie is on the other side. She gets out the glucose meter and shows everyone the chip that you have to change with every new bottle of test strips. She then passes out alcohol pads to everyone and informs them that they'll be testing their own sugar. No big deal... right?!?! WRONG!!! Jason starts flipping out! Why??? Because he can't stand to be around needles!!! Hmmm... lets think about that. For anyone that doesn't know my brother, he's about 6'5" and 250 lbs, with 4 tattoos, volunteer fire fighter and his roommate is an EMT! I know that there are lots of people who are afraid of needles, but most of the don't have about 4 tattoos! We argued this fact with him and he still threw a big fit about it! Why did he even come in the first place? Okay, so he admitted that he was there for the lunch afterwards, but still, he knew that there would be needles in the same room! Dani was getting restless so I took her out to the waiting room to play with some toys. When we came back in, they were done testing sugar and some how managed to talk him into doing it.

Next came the shots. Everyone was to give themselves one. Again, shouldn't be a big deal, if your going to give shots to a little kid, you should know how it feels! Tonya and Dad do theirs, no big deal. Then it comes to Jason... will he do it?! NO. =( He again made a big deal about how he's not going to do it, and Josh is giving him the biggest ration of $hit you can imagine! If only I were at the other end of the table, it was the perfect opperturnity to give him a shot because he was going at it with Josh! When the laughter died down, Dad and Tonya said that they had the same thoughts but with as big as he was, they were afraid that he'd swing and do more damage than what it was worth!

For some reason, up to this point, Ellee will not let me give her a shot in the butt! We did it once in the hospital and she wouldn't let us use that spot again. When I use to get Depo shots, I preferred them there, mainly because I couldn't see the needle and it was over as soon as I felt it. So, while we were there, I told Ellee that she could give me a shot in the butt if she wanted to! Talk about estatic!!! Grandma helped her load the syringe up and Ellee gave me the shot! She was so proud of herself for doing that!

Second day at Children's

Thursday, April 23

Busy day with lots of people to meet with. They told us that we can go home tonight as long as we get all of our classes done and her numbers continue to improve.

Last night Josh and I learned how to do the sugar testing and how to give shots. It was easier to watch the nurses give the shots than for us to give them, but we had to start at some point because we couldn't take a nurse home with us!

For some reason, Ellee's sugar was up at breakfast and lunch. We watched for keytones and luckily they were negative. Shortly after lunch, they decided to keep her for one more night to try to get her levels down. That was so disappointed because we just wanted to get out of there, but at the same time, going home was just as scary.

One of the student nurses offered to take Ellee down to the playroom so that Josh and I could go get something to eat. When we got back, El and Maddy were practicing giving shots (minus the needles) to a couple of bears that we had. It was the cutest thing ever! Maddy was nice enough to get a couple of those hospital bracelets and write the bear's name on it! Ellee was so proud of herself for giving the bear a shot that she was showing everyone how to do it!

Later on, Maddy took Ellee and another little girl (3 years old) out to the rooftop playground. We are up on the 6th floor and can see this from our room. She had been begging to get out there and play and it was heartbreaking to tell her no we've had too many people to meet with. El really needed this fun break and it was nice to meet some one her age going through the same thing.

When El and I got back from the playground, they told us that we could still go home tonight as long as we got all of our classes done. It was a mad rush to get everyone in there that we needed to see still, but we managed to do it! It was a mad dash with Beth going over the rest of the "classes" that we had to go through and test on. It felt like we walked into an advanced French class and had to cram for a test without knowing a bit of the basics of the language. When Dr. Steve said that we'd be overwhelmed with classes and info, he wasn't joking - that is exactly how we felt! I completely forgot about calling Mom to tell her the good news that we'd be coming home tonight, and the next thing we know - here they are! Oops... That was a long way for them to drive, just for us to go home, but it was so nice to have them there with us!

Winnie came in to go over our meter with us and spoke with Mom and Dad about having them come down for classes. Karen also stopped in to go over some stuff with us and we spoke about her dosage. Before we were able to walk out the door, they had already dropped her dosage down a half a unit. It may not sound like much, but any sign that we have it under control or that she's entering her "honeymoon" period is a victory!

Walking out of that hospital with our daughter was a great feeling! I know that some people who enter that hospital don't get to leave with their child. I know it's a grim way of looking at things, after seeing what some of the other kids in there are going through, it made the shots a little more tolerable. If having to do 4 shots a day is the price we have to pay to be able to take her home, then that small sacrifice! The girls rode with Grandma and Grandpa, and I wanted to stop at Tuttle Mall to pick up one of those Carb Bibles and look for ID jewerly.

At Tuttle, I went to the Things Remembered and looked for a bracelet to get engraved for her to wear. It was a little disappointing to find out that most of their stuff was too big. I did manage to find a cute one that was on sale that was slightly smaller and didn't fall off when she dropped her hand. Little did I know that this would be the first of many disappointments with trying to find ID jewerly for her to wear!

We go to leave the mall, the girls are in the truck with us and we're getting ready to leave when Ellee says some thing so small, but yet it throws Josh and I into a panic... "I'm Hungry". UUURRRGGGEEE... where are the nurses when you need them?! What do we do? It's almost 9pm and there isn't very much open and we know that he have to give her something that is 15 carbs or less. Mom suggests the apples from McDonalds, so I pull out my new Carb Bible and look them up. Great! The apples are less than 15, but she loves the "apple sauce" and that would put her up to 23 carbs. We didn't really have a choice, so we went ahead and got them for her. It sounds weird and sounds like something so trivial, but for newly diagnosed parents, this was a hard decision, what do we do? Since I am writing this a while late, I will say that looking back, I can't believe that we paniced about that! Now at night we purposely give her extra carbs to raise her level up to avoid a night time low!

Thursday, June 11, 2009

First Day at Childrens Hospital

Wednesday, April 22

We have SOOOO much to learn over the next few days. We have really didn't know how long we would be there because we didn't know how long these classes would take or how long it would take to get Ellee's levels straightened out. We met Beth, the lady who will be our day nurse for the next two days. She gave us the run down on the disease, what likely caused it and the course of action we would be taking. She also gave us a brief rundown on how to order food for Ellee. They had a neat little menu with a good assortment of food and the carbs listed behind it. For now, we had an allotment of 30-45 grams of carbs that she can eat per meal. For breakfast, that was a little hard to stick with because she loves pancakes, but for other meals, it was hard to get up to that 30.

I don't know how to explain that day other than Josh and I felt like we were stuck in slow motion and every thing around us was in fast forward. There was so much information to learn but for some reason we couldn't get past the first sentence - "your daughter has diabetes". Have you ever had to read a book for school and after you "read" the first page, the only thing that your remember and comprehend is the first line? It's like the book Tale of Two Cities, all I remember is the first line - "It was the best of times, it was the worst of times".

Ellee was pretty groggy for the first part of the day. I dreaded the time when she would say that she was hungry. We had to try to get her to tell us what she wanted to eat and make sure that we had the right amount of carbs, order it, then wait about 45 minutes for it to get to the room. Then the horror show begins. By the time the food gets there, she is starving and cranky. But before she can eat, we have to poke her finger and get blood. If the meter reads above a certain number, then they have to try to fill up this little tube with blood to send down to the lab to verify the level. Next is the worse part - the shot. It would would take both of us and some times another nurse to hold and try to calm her down while Beth gave her the shot. Now she can eat, and I would pray that she would like the food because if she didn't eat it, then we'd have to substitute food that she would eat to make sure she had ingested the right amount of carbs for the insulin dose that they gave.

Shortly after lunch, Ellee started to feel better. She was smiling and was more playful & goofy. We were finally getting our Elizabeth back! That afternoon, we were so thrilled when Beth said that they would unhook the IV, but they were going to leave "the straw" in just in case they wanted one more blood draw. Figures, about the time Ellee got use to maneuvering the stand and cords when she had to go to the bathroom, they unhooked her! Okay, time for my rant... why wouldn't they put children size furniture in a CHILDREN'S hospital??? The toilet was just a tad too high for her and with the straw in her arm, she couldn't lift herself up so one of us had to go with her every time. Then the sink was just a tad too high and it made it difficult to wash her hands. Okay, I'm done!

The day was filled with meeting lots of new people . I think at one point all 5 of the people that we were suppose to meet with were in there to decide what time they would come back and go over their spiel with us. Not to mention the countless nurses who were doing their clinical that would come in and ask if they could check her stats. It was one of those things where when we were alone, no one wanted to see us, but when we had a visitor, everyone came to visit! When Wynola was talking with us, we had umpteen nurses, plus all of the Endos stop in while doing their rounds!

I remember the dietitian talking with us. Questions about her eating habits, how to calculate carbs, how much at each meal. Very over whelming. That was another moment when we felt like we were in a fog. Things were making sense, but they weren't really sinking in.

Mom had found the greatest things ever invented! Twistable Crayons!!! It doesn't sound like much to get excited over, but for a child that pushes really hard when they write and constantly break crayons... these things are wonderful! They hardly broke, and if they did, then we just lost a little bit of it. Can anything get better than that? YES... Fat Twistable Crayons!!! Mom's goody pack that she sent up with us was great! It kept Ellee busy for most of the day till we were able to go find the playroom in early evening after all the educators left for the day.

I have to say that I'm so thankful that Dad decided to take the retirement option from the State when he did. I don't know what we would have done through all of this if he wasn't able to watch Danica for us. It also helped that Mom was working the M-F day shift position that she's in now. Not having to worry about Dani so that we could concentrate made things go a lot smoother. After Mom got off of work that day, they brought Dani up to the hospital to visit.

While they were there, they told us to go some where and get some thing to eat. We went to Pizzaria Uno. We talked a little bit, but we mostly sat there holding hands and crying. We can get through this, but the next month is going to be VERY rough.

Sure enough, they wanted one more blood draw. For some reason, Ellee didn't want them to take the straw out when they were done. I think she just got use to it being in there, so it took some coaxing to get her to let them take it out. It probably hurt more to get all the tape off from the split that kept her elbow extended than it did to take the straw out!

We all three had a rough day. Josh went to sleep on the couch and El and I got a Winnie the Pooh movie out of the closet in the hall way to watch. At that point we haven't really explained to her what all was going on. She just knew that she had this IV in her arm and that she had got pokes and shots quite a bit that day. I was laying in bed with her watching the movie and we started talking. "Hunny, I know that you don't understand what is going on, but you have some thing in your body that isn't working like it should so we have to give you these shots to make up for it." "Oh, okay... Why doesn't it work?" "I wish we knew. We have to get use to these shots so because the medicine will make you feel better." "Okay. I love you mommy. Good night." "I love you too baby. Get some sleep."

I think every parent watches over their newborn baby as they sleep. That baby is the a wonderful gift that you've been given and have to figure out how to take care of it. They admire that cute little bundle that is so peaceful while sleeping, yet worry about what if something goes wrong. I laid there watching her sleep while while brushing her hair off of her face. Exactly 4 years ago we were in a hospital with her starting a new journey in our life. Here we are today, in a hospital again, on the same journey, but we had to take a slight detour.

Arrival at Childrens Hospital - Columbus

Tuesday, April 21

Talk about a long drive, so I was so glad when she finally fell asleep half way there! When we first started out, she couldn't really see out the back window very well because she was so low, but for some reason was trying to pick out sites that she recognized to see where we were. We were right down the road from one place I knew she'd know, so I pointed out her friend Savannah's house. We read a George book, then about the time we picked up 33 around Huntsville, she fell asleep. I chatted with the EMT for the rest of the trip. We talked about how you don't know how strong you are until you are faced with a challenge, you do what you have to do.

I was very impressed when we got to the hospital. When they wheeled us in, the gal knew exactly who we were and where we were going. Those wheels on the stretcher never stopped once from the door till we got to our room! On the way through the hall a male nurse or intern gave Ellee a beanie baby! Once we got up to our room, we got El settled into her new bed and the nurse checked her stats and sugar so that she could go back to sleep. After she went back to sleep, the nurse briefly explained what all will happen. We had 5 people that we had to meet with and 5 "classes" that we had to take. she wrote every thing up on the dry erase board with a line to x them off as we did them.

Josh got to there shortly after we did. I was exhausted so I laid down on the couch to get some sleep. I remember a nurse coming in to check her sugar in the middle of the night and Josh was up helping her. After that he couldn't get back to sleep in the chair, so we switched places.

First Hospital - Lima Memorial

Tuesday, April 21

I hate to say it, but I'm glad that I missed the insertion of the IV.  In 6 months I've had to sit with her twice through blood draws she freaks out around those "straws".  In October, after a blood draw to check for lead, she talked about how that needle "bit her" for a month! 

I got to the room just in time for her first finger poke and blood glucose check.  668.  I was upset that it was that high. This is where the self blame comes in.  Why did we let it get this high?  Why didn't we bring her in earlier?  Why didn't we recognize the signs earlier?  Dr. Steve kept telling us not to worry about her numbers.  He also put things in perspective pretty well... even if we had caught it earlier, we'd still end up in the same place.  He was very right.  And as I found out later on after talking with other people, her diagnosis number was quite low, compaired to what some others were when they were diagnosed.  Some were around 800, and some one else I talked to was up around 1,200.  The important thing is that we caught it before she went into a coma. 

Ellee got her first dose of insulin.   I think it took two nurses and both of us to hold her down to get it done.  Poor kid, she has no idea why she's in there, why she has an IV, or why they are poking her fingers or giving her a shot.  It took quite a few minutes to calm her down and I can't blame her, she has evey right to be upset.  They brought her up dinner, but she just picked at it.  She had a rough afternoon and just wasn't all that hungry.

They arranged for the ambulance to transport us to Columbus at 8:30.  The nurses change shifts at 8 and it gave them time to come around and do vitals before we left.  I don't think it was more than an hour and a half after I called mom and they were up there at the hospital.  They brought at goody bag for Ellee - coloring books and crayons, and plenty of George the Monkey books to read!  Josh left to get Dani from Tonya's house, then went down to Wapak to talk to his dad and brother before going home to pack clothes and head down to Columbus.

We had a few hours to kill and spent most of it over in the playroom that was right next door.  It was a pretty somber mood in there until Dr. Steve came in to cheer things up! I think there were a few points where he had me laughing through my tears! 

The EMT came a little early, but in a way I was glad to head out and get to Childrens to get this process started.  

Tuesday, June 2, 2009

Second Doctors Appointment

Tuesday, April 21

After her draw, we went up stairs to the doctor's office. We waited in the waiting room briefly, then they took us back to one of the larger rooms to wait for the results of the blood test. We were hoping to meet with Dr. Steve but it was mentioned earlier that he is on call for the night and didn't get in till 4. A nurse came in and took Ellee's stats and left.

We were both on pins and needles waiting for a doctor to come in. We had no idea what all this would entail or what would happen next. Poor Ellee was so tired that she curled up on Josh's lap and fell asleep against his chest.

After a while, Dr. Mary came in to see us. "Elizabeth is Type 1 Diabetic and right now her glucose levels are sky high. You need to decide what hospital and Endocrynologist you want to use so that she can be admited as soon as possible." Those are some of the hardest words a parent can ever hear. An Endo-what??? Dr. Mary was very wonderful with explaining our options. The bad news is that the only Endo in town mainly deals with adults, not children. Now we have to decide what Children's Hospital we want to go to. Josh laid Ellee on the examining table since she was still sleeping. They brought in maps to the closest Childrens along with where their satelite offices were and left us to decide what we want to do. Josh got on the phone to call work to find out which Endos were in our network and the whole time I'm still trying to figure out how to pronounce it!

Dr. Steve came in to check on us. I think he was filled in ahead of time on Ellee's condition since he'd have to deal with us tonight. He explained that we needed to admit her as soon as possible to get her hooked up to an IV to get all of that excess sugar flushed out of her system. We all agreed that it would be best to admit her to Lima Memorial to get every thing started, then have her transfered to Childrens in Columbus after they verified that they had a bed ready for her. Knowing how much an abulance ride costs after my two rides last year, I wasn't excited about seeing that bill, but at this point, it was the least of our worries!

Josh and I had to decide who was going to stay at the hospital with her, what to do with Dani, and what seemed like a thousand other things that needed dealt with to get us through the week. Luckily, my boss assured me not to worry about work and that they would get every thing taken care of for how ever long I needed to be gone. We decided that I would stay with her at the hospital and he would get Dani and pack clothes for us. I wanted to go to the library to get books and read up on all of this over the next few days, so he went with them to admit her to LMH while I was gone.

This was definitly the hardest phone call I ever had to make. On the way to the library, I called mom. "Is dad there too?" "No, he's up at Jason's." Oh, I was hoping to have them put me on speaker phone so that I could explain it to both. "Sit down... Ellee has Type 1 Diabetes and needs to be admitted to the hospital". We both bawled through that conversation. I don't really remember the rest of it except for asking if they could take Dani while we were in Columbus.

Why are there so few books on this subject? And as I soon found out, so many books lump Type 1 and Type 2 together, when they are almost opposite. One book that I picked up that ended up being the best one was a book "How to Parent a Child with Diabetes" by Gloria (don't remember the last name). I ended up getting all the techinical information I could handle (plus more) from the nurses in Columbus, but this book was from a mother's view. Armed with 5 books, I headed back to the hospital to start this new path of our lives.