Monday, December 19, 2011

Christmas Party (Combo Bolus Rocks!)

Our family recently attended a wonderful Christmas party given by a few of our dear friends.  This party was amazing with buffets in various rooms set according to theme... appetizers, entrees, beverages and my personal favorite, desserts.

And did I mention that the desserts buffet had a melted fountain of chocolate?  And with things to dip like potato chips, mini marshmallows, strawberries and pretzels?  Oh yes!  It did!  And yes, we tried it all. 

Back in the beginning of our arrival into type 1 diabetes land, this type of setting would have made have made me break out into a cold sweat and feel instantly nauseous. 

How could a parent safely let a child with type 1 diabetes eat without numerous doses of insulin?  I thought I had to grab a plate, measure food, carefully count carbs and then limit my child from eating anything else during the party.

And then I had to pretend to have fun while stressing over the fact that my child was not in the least bit satisfied with one small serving and was whining for more. 

In a nutshell, parties stunk. 

Somewhere along the way, I realized that unless we wanted to become hermits, I needed to get a handle on dealing with parties.  Since parties are part of life, really, I needed to learn to embrace LIFE.

At the time, I was doing a lot of reading on type 1 diabetes.  How in the world did other people manage?  One of my favorite books was written by Gary Scheinder, MS, CDE  and entitled "Think Like a Pancreas".  If you never get the opportunity to read his book, one of the most important and thought provoking ideas is right in the title... think like a pancreas

Without risking becoming too deep in thought, just thinking like a pancreas made a lot of sense.

Party food isn't eaten all at once, so why bolus only one time? 

If I just think like a pancreas, that one dose of insulin isn't really how my daughter's own pancreas would have handled the onslaught of carbohydrates. 

And how could we manage this problem in the real world? 

Enter in the magical Combo Bolus on our Animas Ping insulin pumps. 

A combo bolus allows the recipient to enter in a total amount of carbs and then dose a percentage over a set amount of time. 

Putting some numbers to this, I can provide a real-life example of the way this works in our family. 

My youngest daughter usually eats about 60 carbs for a meal.  At dinner time, she is at a ratio of 1 unit to every 15 carbs of insulin. 

To combo bolus her at the party we went to,  I applied 60 carbs of carbohydrates which equalled to 4 units of insulin.  Instead of giving her four units at once, I gave her a ratio of 1/2 of the insulin at the start of the bolus and 1/2 of the insulin at the end of the bolus, set in the pump for one hour later. 

And because it is an automatic process, once we entered it, we could just tuck the pump away and not have to bother with it again. 

Because she is 8, I was able to allow her a bit of freedom in counting her carbs and working her way up to the 60 total carbs.  As she my daughter, I knew that we wouldn't have a problem reaching the 60 (oh those yummy desserts) carbohydrates. 

She kept a running tab for the 60 carbs.  In our family, we usually start at one carb and work our way up to sixty, but I have met other families who start at 60 and count backwards.  To keep count, you can either trust your memory or another strategy is to make little tears in your napkin for every ten carbs eaten.  The nice thing is that a napkin can be folded up into your pocket and no one is any wiser of what you are doing.  One of my adult friend uses toothpicks.  She pockets the toothpicks and counts that way.  Whatever works. 

My oldest daughter loves to combo-bolus because she feels like it allows her to feel less bogged down with diabetes.  This is a HUGE concern of mine.  I want her to feel positive about managing her type 1 diabetes so that she doesn't one day (especially during her teenage rebellion years) decide that it is just easier to ignore diabetes. 

She also loves the way she feels.  Less spikes and higher numbers.  One of her favorite times to use the combo bolus is when she decides to eat pizza.  The slow release of carbs from the pizza is difficult to manage with the fast acting insulin.  Without a combo bolus the insulin is done working before the pizza is done fully digesting.

The end result of our party???  Well, the chocolate fountain was just wonderful!  Oh, and blood sugars were very, very good with a nice 159 when we got home.

The best part was the ability for our entire family to mingle and enjoy the moment without the diabetes monster taking over.

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