High Ketones

Last Thursday was a very hard day for Amanda.  Wednesday night her blood sugar was in the 400's.  So we changed her infusion set. Not sure why it was so high that night.  She hadn't checked her blood sugar all day.  Not Good.  And I think it had been too long since she had changed her set (which should be changed every 3-4 days).  Not Good.  Well all we could do at that point is change the set.  Thinking all is good now.  She goes to bed.  She checks it a little later and it is in the 300's.  Okay, all is good. It is coming down.  Later in the night she gets up thirsty.  We check again- back in the 400's.  I give her  a bolus and go back to bed.

Next morning, she is in the 500's.  I ask her to check her ketones.  It reads HIGH.  NOT GOOD.  She hasn't had high ketones since she was diagnosed 8 years ago.  Here is the definition of ketones according to the Joslin Diabetes Center:

Ketones are produced when the body burns fat for energy or fuel. They are also produced when you lose weight or if there is not enough insulin to help your body use sugar for energy. Without enough insulin, glucose builds up in the blood. Since the body is unable to use glucose for energy, it breaks down fat instead. When this occurs, ketones form in the blood and spill into the urine. These ketones can make you very sick.



These ketones can make you very sick is an understatement.  She was throwing up and very weak. We called her doctor and talked to her regularly all day.  We disconnected her pump and started shots. We had to give her phenergan and slowly introduce sprite mixed with sprite zero.  Once she was able to keep it down, she needed fluids to bring the ketones down.  The ketones and blood sugar had to come down similarly.  So it was a balancing act to bring the sugars down but not too fast.

By bedtime, she was in the 300's and had trace ketones. We were able to put her pump back on.  After pulling off the last infusion set we noticed that the tubing that is inserted right under her skin had crimped. So she wasn't getting any of her insulin on Wednesday night.

Friday morning all was back to normal (Not that any of this is normal).

This could have been a hospital visit.  I am so thankful for our doctors and nurses at the Endocrine Clinic.

Genetics and Diabetes (Joslin Diabetes Center)

Type 1 Diabetes Odds

Just who is at risk for developing type 1 diabetes? Here's a sampling of what Dr. Warram, a Lecturer in Epidemiology at Harvard School of Public Health, said is known:

• If an immediate relative (parent, brother, sister, son or daughter) has type 1 diabetes, one's risk of developing type 1 diabetes is 10 to 20 times the risk of the general population; your risk can go from 1 in 100 to roughly 1 in 10 or possibly higher, depending on which family member has the diabetes and when they developed it.
• If one child in a family has type 1 diabetes, their siblings have about a 1 in 10 risk of developing it by age 50.
• The risk for a child of a parent with type 1 diabetes is lower if it is the mother — rather than the father — who has diabetes. "If the father has it, the risk is about 1 in 10 (10 percent) that his child will develop type 1 diabetes — the same as the risk to a sibling of an affected child," Dr. Warram says. On the other hand, if the mother has type 1 diabetes and is age 25 or younger when the child is born, the risk is reduced to 1 in 25 (4 percent) and if the mother is over age 25, the risk drops to 1 in 100 — virtually the same as the average American.
• If one of the parents developed type 1 diabetes before age 11, their child's risk of developing type 1 diabetes is somewhat higher than these figures and lower if the parent was diagnosed after their 11th birthday.
• About 1 in 7 people with type 1 has a condition known as type 2 polyglandular autoimmune syndrome. In addition to type 1 diabetes, these people have thyroid disease, malfunctioning adrenal glands and sometimes other immune disorders. For those with this syndrome, the child's risk of having the syndrome, including type 1 diabetes, is 1 in 2, according to the American Diabetes Association (ADA).

Caucasians (whites) have a higher risk of type 1 diabetes than any other race. Whether this is due to differences in environment or genes is unclear. Even among whites, most people who are susceptible do not develop diabetes. Therefore, scientists are studying what environmental factors may be at work. Genes influencing the function of the immune system are the most closely linked to type 1 diabetes susceptibility, regardless of race. One of those genes is HLA-DR. Most Caucasians with diabetes carry alleles (gene variants) 3 and/or 4 of the HLA-DR gene. The HLA-DR7 allele plays a role in diabetes in blacks, while HLA-DR9 allele is important in diabetes among Japanese.

Day at Incredible Pizza with JDRF

JDRF had a kick-off for the Walk to Cure Diabetes at Incredible Pizza. This will be the first year that both of my girls are participating as diabetics. The three of us have decided to volunteer this year instead of forming a team to walk. However, Amanda has created a page to raise money.  The walk will be at Shelby Farms on October 1. We will be at the information booth if you come out.

I have the most incredible story about Time. It has happened twice so I am going to post it. Amanda's cousin lives just around the corner. One night she was there and Time was here. Time started alerting. We told her that Amanda wasn't here. We let her out in case she needed to "take a break". We let her back in and she insisted on alerting. So, we called Amanda and asked her to check her blood. Her blood sugar was low. We laughed and thought that was really an incredible coincidence. Just the other night, she again was at her cousins. Both times Amanda was outside. Time alerted. Since Adrienne was home and is now a diabetic, we had Adrienne check her blood. All was normal. We let Time out to "take a break". She came back in still insisting on alerting. So, we call Amanda. She was in the pool, got out and checked her blood. She was at 58. Wow! I love our dog.

Oxford Run 4 Hope Coming Up

Check out my link for the Oxford Run 4 Hope. It will be a 5K and Half Marathon to raise money for Camp Hopewell. This camp has a week in the summer just for kids and youth with Type 1 Diabetes. It is staffed with a doctor and nurses who volunteer their time. The goal is to raise enough money to make camp available for free. Amanda has loved her camp experience.

Dr. Becky is getting the cabin 7 girls together to cheer on the Marathon runners in their last 1/2 mile. This is also in honor of Lindsi, who died this year due to complications from her Diabetes. She was in cabin 7 with Amanda.

Amanda, Adrienne and I will be there to volunteer and cheer on the runners.

Adrienne is Diagnosed with Type 1 Diabetes

Adrienne is my 20 year old and is a junior at the University of Memphis. Three weeks ago, she was taking exams and remembers being extremely thirsty that week. She would down three bottled waters and it would not quench her thirst. When exams were over she mentioned that to me and the fact that she was going to the bathroom a whole lot. So, I asked her to check her blood and let's rule that out. Well, she checked and her blood glucose was 500. I'm afraid we didn't rule it out. I called Amanda's endocrinologist right away. I happened to have her cell phone number from a previous conversation about Amanda's blood work. I just jotted it down for future reference. Never dreamed I would need it so soon. Dr. Karabell was kind enough to answer my phone call even though she was with a patient. She asked me to check her ketones and call her back in 5 minutes. No ketones. I'm praising the Lord for that. You start getting into trouble when that happens. It was a very long 5 minutes. When I called her back she said to come in right away.

We were seen fairly quickly. She gave Adrienne her first insulin shot with an insulin pen. She needs a shot twice a day at this point. She wants her on a pump as soon as possible. It just makes life much more manageable on the pump.

It's been over 2 weeks now since diagnosis. Adrienne is doing amazingly well. She has watched her sister for 7 years and has been involved in her care. The two of them are bonding like I've never seen before. That is the blessing part of this story. They have each other.

Our new challenge is what to do with Time. She has alerted for Adrienne once on her own. We haven't been sure if we should encourage that or not.

We have known since Adrienne was about 14 that she carried the antibody GAD for Type 1 Diabetes. During some routine blood work, her blood glucose that day was over 200. The doctor said that we need to check that out. I took her to the endocrinologist and they ran a test that would show if she carried the antibody for Type 1 and she did. At the time, the doc said that she would develop it in the next year. Well, the year came and went and then another and another. I decided that it was not going to happen.

Last summer after Adrienne's trip to Ecuador, she was very fatigued for a very long time. I started checking her blood sugars at random and found that she was running in the 200's again on occasion. Dr. Karabell checked her A1c which checks how your blood sugars are running for the past 3 months. It was a perfect 5.1. She said not to worry about diabetes; she does not have it. The Lord gave her another semester without diabetes. For that I am thankful. She finished her semester with 4 A's and 1 B and an Excellent portfolio for the graphic design department. For that I am thankful. She has 4 weeks before school starts to learn how to manage it for herself. For that I am thankful. And, she has a sister that can help her. For that I am thankful.

A Week of Check Ups

We had a week of check-ups. First the pediatric opthamologist. Her eyes are checked once a year for diabetic retinopathy. She still has beautiful blue eyes and no retinopathy.

Here she is using her time wisely and knitting. That's my girl!

This is our very favorite opthamologist, Dr. Pandya. She has taken care of all my kids for many years.
Then, we had an endocrinologist appointment. She has to go every three months for a check-up. Once a year she has to do blood work. This sweet lady has been drawing her blood since she was diagnosed in 2003.
And, this is our wonderful endocrinologist, Dr. Ana Karabel. She was sweet enough to talk to us about Lindsi's untimely death. She gave comfort and warning and challenged Amanda to be an ambassador for diabetes. She was thankful that Amanda has Time to give warning and wished all kids could have an alert dog.

JDRF Walk 2010

We didn't really make plans for the walk this year. We didn't raise money or form a team. My girls and niece and I just went.

It was a very sobering year. Just days before the walk, we got news that one of Amanda's camp friends had died as a result of her diabetes. It was devastating news. Amanda had roomed with her at camp for 2 years.

What we understand is that her blood sugars had been quite erratic all week. She was checked during the night twice. Once her blood sugar was low and the second time it was normal. But the next morning she was in a diabetic coma. She was already brain dead. They are suspecting that her blood sugar had spiked and her ketones went very high and she went into a coma.

This is frightening news for a parent. I went to the pharmacy to stock up on ketone strips. It is a simple urine test that can be done if your blood sugars are over 240 or if you are sick to measure the ketones in the body. Ketones are a result of your body using its own fat for energy. I had always assumed that if the blood sugar came down so would the ketones. I've learned it is not necessarily true. So, Amanda will always check her ketones along with her blood sugar.

I want Amanda to learn that she is to be responsible in caring for herself and at the same time trust in the Sovereignty of God. I feel like God must have been ready for sweet Lindsi to come home. I know she was well cared for. This walk was dedicated to her.

Time with her favorite toy

I just haven't posted anything in a while. So, I thought I would show you what Time's favorite toy is. She loves a 2 ltr bottle with the cap on. She has figured out how to unscrew the cap and collapse the bottle so she can carry it around.

Home from Camp

Amanda is home from camp. We got 3 letters from her this year. A new record. She had a great time. The first 2 years she was spoiled by the "Overlook" cabin. It was bigger and newer with a nice room in between the bedrooms. This year her cabin was a bit smaller. But, hey, I think if you have a bathroom in your cabin at camp, you are doing pretty well. She said that she knew all but 2 of the people in her cabin and she knows them now.

She took me on a tour when I picked her up.


They swam and canoed. They had a low challenge and a high challenge. They had to complete the high challenge in order to do the zip line. She really wanted to do the zip line, but couldn't get up the nerve to do the high challenge. She said she would do it next year.

She said that she didn't get homesick, but really missed her bed. On Friday night, right before the dance, she was playing around on the bunk and hit her pinky toe. She said it hurt, but laughed it off. When she got home it was pretty swollen. I really think she broke it. Either way, she hobbled on it for about 3 days. It was pretty bruised. I guess that is her camp story. But, it didn't keep her from dancing at the dance.

Camp Hopewell

Tony and I took Amanda to Camp Hopewell in Oxford yesterday. This is her third year to go. I just can't brag enough about this camp. It is a time for her to go and be a kid and do all the activities that you would expect at a camp. It is staffed with a doctor and nurses.

When we check her in, we go to different stations that address different issues. One, of course, is the camp nurse. She checks her temperature and asks about any other illnesses, checks weight and height. Amanda not only has Type 1 Diabetes, but she has a blood disorder called Von Willebrands. Some of her platelets are inactive, so it may take a little more time to stop any bleeding. It is generally not a very big issue. It would generally take surgery or a very big injury for it to become an issue.

Another station is her cabin nurse. I think Amanda was quite relieved to see that she was her nurse from last year. The nurse could not believe how much Amanda had grown. She put her at ease right away. One of the issues that Amanda was nervous about was the fact that she has still not changed her own site. She knew that most kids her age were doing this. I'm hoping that she will get over that fear this week at camp and have that accomplishment to bring home with her. The camp encourages you to do something that you haven't done before. They never make you do something that you are not ready for. I talked to the camp doctor last year about when I should make her change her own site. She wisely told me that peer pressure will do that. And, sure enough, this year it has been a concern for her and she truly has tried to do it herself without me pushing for it. So, I know she WANTS to.

Another station that we visited had different vendors for different diabetic needs. But the one we visited that we were excited about was a Run for Hope. This is a 5K and Half Marathon Run that will be February 26. The money will be raised so that Camp Hopewell can offer full scholarships for every child with Type 1 Diabetes to go to camp. I'm tearing up as I write this. It is truly an experience I wouldn't want any child to miss. And currently the cost for camp is $390 per child for the week.

Well at the end she could go and join her cabin group and she hugged us said "goodbye" before we got too close to the group. I guess she didn't want us to walk her over there. Haha. She has friends that she has made from the first two years and I know she will come home with new friends this year.

The Latest Happenings

A few weeks ago Aaron, Austin and Adrienne were away for the week. Amanda got to experience being an only child. We ate out a few times and spent one day in Oxford. We had lunch, shopped in the antique stores and ......

got to spend some time in the Candy Store. Every little girl's dream (diabetic or not). We had ice cream and yes, she picked out a bag full of candy. You really can have sugar when you are diabetic. But, you have to count carbs carefully and give yourself enough insulin to cover those carbs. It is, of course, not the ideal food, but it is nice to have a treat every now and then.

My Artist

Amanda has loved drawing from the time she could pick up a pencil. She drew Time yesterday and I really wanted to share it. Also, a scene from Narnia's Prince Caspian. We have the movie and some one gave her a set of the books on CD's. She hasn't felt very good for the last couple of days. She stayed in bed listening and drawing. Just wanted to share some of her art work.

I thought I would also include the picture she drew when she was first diagnosed at the age of 6 sitting in the doctor's office waiting. We were sent immediately to the endocrinologist from the pediatrician's office the day she was diagnosed. Then we spent the next few days back in the office for training. The picture she drew was the day after she was diagnosed while we were waiting. Even though there are tears, I was glad to see a smile as well. She has been an incredible little girl and now young lady.

Confuscius says...

We got take-out Chinese the other night for supper. So there have been a few fortune cookies laying around. Amanda opened one today and it says.......

Time is the wisest counselor

Snow Day

Time loves the snow. We woke up to 7" of snow this morning to the surprise of the weathermen.