Tuesday, November 8, 2016

November is National Diabetes Awareness Month: Lessons Learned About Sleepovers

October was a big month for our youngest.  Not only did she officially turn 13, but she also had several friends that celebrated birthdays during the same time frame.  Since all of the girls are wonderful friends (about a dozen teenaged besties in total), large, fun sleepovers were held to celebrate the big days of each individual girl.  To our youngest daughter, this was easily the most exciting time of year.

Our 'rules' for sleepovers are fairly straightforward.  I have posted stories about it here and here.  As the girls have grown, plus with the addition of new technology, we as a family have adapted the game plan to better suit all of our needs.  Mostly, I need to know that they have caught the low before it gets to a ridiculous number that would require mom to drive like a maniac to bring them juice and glucagon.  On their side, they need to bring a charger for their cell phone because nothing is worse than not being able to snap chat and yes of course, read those Dexcom Share numbers.

For the first sleepover, the girls were invited to a local movie as part of the activities.  The family borrowed a large mini-bus and impressively had all of the girls safely riding together to and from the theater.  Our youngest daughter followed her 'mom sleepover instructions' to text me just as she began to treat a 90mg/dl blood sugar (knowing that a drop was headed her way) and then called me right before bed time to review her bg, any IOB and to confirm that next to her sleeping bag were safely stored juice boxes (just in case) and her cell phone both plugged in and charging.  The next morning, she happily came home and promptly took a nap as the girls were well awake past 3:00 a.m..

During the second sleepover, our youngest daughter planned a night-time scavenger hunt throughout the neighborhood with her large group of friends.  Returning back home after running around, the girls sang karaoke, danced and played air hockey.  Activity stayed high throughout the evening and the girls had trouble settling down.  Somewhere around 4:00 a.m., the last one finally went to bed.  However, since it was at our house, it was easy for me to help discreetly guide extra snacks for pesky lows and to give not so subtle reminders to the girls TO GO TO BED.

By the time the third sleepover in a row rolled around, our youngest was a bit short on sleep and attitude.  Various hormonal factors played into the not-so-sweet attitude and her blood sugar was already in a whirlwind before the evening and before leaving our home.  I should also mention that the day prior was spent at our quarterly endocrine appointment and while I can't say exactly why this is, the attitude towards T1D is always more upset than what would be typical.  With the perfect storm already brewing, we sent our youngest daughter on her way with extra snacks, juices and a birthday present for the party.

This is where I am going to share what I did to further contribute to the forthcoming mayhem...

  • I did not check her blood sugar infusion site to see if it looked good or needed to be changed.
  • I did not check her insulin cartridge levels within her pump.
  • I did not send her with extra insulin.  
  • I did not spell out a specific consequence for not communicating with me.

From those missing items, if you are parenting a child that lives with T1D, you can probably imagine what happened but I will share the full story.  As a parent, I needed a reminder to myself that no matter how adult she may act most of the day, that I am still her reminder for many things - the above list is probably the most important and well, I blew it.  

First, our youngest started to go low, treated on her own and thought that we as her parents would figure it out on our own.  However, her Dexcom Share CGM was in the 'sudden drop' mode of two arrows pointed downward and despite my effort to not call her, when the number flickered at 41 mg/dl, I started dialing like a mad woman.  First our daughter, than the sweet hosting mom and finally, friends and friend's parents.  True story.  I actually texted the mom of her friend in hopes of getting daughter to respond.  While that was happening, my husband was roaring out of the driveway on his way to the house to get her.  Fear.Makes.Parents.CRAZY!

And then the text that I received, "Calm down.  I am fine."


At that point, an angry call led to an unhappy daughter that promised us she would communicate throughout the rest of the night and a grumbling, upset parent duo that are arguing over what to do with the child causing the chaos.  No fun at all.

However, close to midnight (and for a change all of the girls were feeling exhausted), our youngest suddenly realized that she was in trouble.  On her bedtime call to me, in listening her to ramble about various things, the tone in her voice was worried.  Finally, a bit of questioning prompted an admittance that her cartridge beeped a low-reservoir warning.  Adding to that, her blood sugar started to spike as she had made a decision to not dose when correcting the low with goodies and she had silenced her CGM by accidently restarting it (requiring a two-hour warm-up).  With the pressing need for insulin looming combined with her worry about how much insulin to correct with, she broke down on her cell phone and agreed to return home, missing out of the rest of the fun party.  

The kicker?  Before she went to sleep in her own bed, I checked her BG and it was mid 500s, about 250 points higher than what she thought or even what her CGM had been reading just a half hour before that.  We know that her thinking was impaired as was her ability to sense futher highs and lows.  We quickly changed the infusion site and saw it was red, irritated and bent at the tip.  I gave her an injection to bring down the high quickly and stayed up through the night to watch for ketones, extra boluses and crashes.  By morning she was in perfect range, feeling a bit of a diabetes hang-over and also very sorry for her attitude and actions.

As a result, the punishment for the situation was resolved before we even woke.  Leaving the party had been pure torture to our daughter and a reminder to all of us that we need to be more clear on expectations, increase our communication to one another and utilize a checklist of what should occur for future sleepovers - including check on insulin needs and infusion sites.  

I'm sharing my learning with you as it does take a village with T1D.  I am so happy that my daughters have friends that are willing to have our girls over to spend the night, despite the worries that come along with T1D.  This past weekend, our daughter was invited again to another friend's house and the night went just as it should... kids first, diabetes second.  <3 

#NDAM #Sleepover #Natsweetsisters

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