Food issues...

I'm not sure what has been going on with Bekah's BG.  It seems like her insulin needs have changed since being sick.  I have been doing a temp basal increase during the day but have been afraid to mess with anything at night.  Her numbers at night have been crazy high though.  Last night we had a 274 at midnight that I did a correction for then Jason got a 326 at 3 AM, did a correction and then she was 333(with 0.0 ketones) when she woke up. (We have been seeing the same thing for a few nights now)  I had just done a site change the afternoon before that I knew was a good one and my instinct said not to change this one just yet.  I gave a correction bolus, fed her cheese and turkey peperoni for breakfast and upped that temp basal +100% (she has tiny basals).  By 9:30 she was down to 256 so I took her to school.  By lunch 182.  I'm not sure what to do tonight.  Temp basal??  To top it off David has decided he doesn't really need sleep until about 2 AM (hello chip off the old block) I'd love to hear any advice if you have any.  I think I will download her meter and fax the logs to our CDEs.  Since I am up with David anyway maybe a basal test is in order?? Is it possible that during this sickness the last little bits of insulin were sputtered out by her pancreas sending her out of the honeymoon?  I'm pulling my hair out and shaking my head.  Why is it that with D, A+B rarely = C?? 

On to the reason behind this blog, sorry for the rabbit trail.  Bekah wanted hot lunch today.  I checked out the nutritional information before I went to the school to get the carb counts.  They had substituted an item that had on the ingredient label strawberries and sugar and had no carb counts anywhere for this item.  I was beyond frusterated and hid my tears behind my hat and glasses as I SWAGged her lunch and gave her the appropriate bolus.  I came home to make a call and couldn't get a hold of the person in charge of the nutritional information so I wrote her an email. 

Hello xxxxxxxxx

I have a daughter in the first grade at xxxxxxxxxxxxxxxx  Elementary School who is a type one diabetic.  I'm not sure how much you know about the disease but it is imperative that all carbohydrates that she consumes be properly accounted for so that her insulin needs can be properly dosed.  If a person with type one diabetes is given too much insulin then they can go in to hypoglycemia which could lead to seizures or even death.  If they are not given enough then their blood sugar could rise causing other complications including DKA (diabetic ketoacidosis) which is the leading cause of death among type one diabetics.  Balancing blood sugar or blood glucose levels is not an easy task.  That being said let me give you a scenario from today. 

I go in to the school on the days that my daughter chooses to have hot lunch to help with her insulin dosing (I'm not sure ahead of time what she will eat and it puts less pressure on her and her teacher).  Today the menu was a pizza pocket, chilled fruit, salad and milk.  The nutritional information given to me was that pizza pocket with a carb count of 46.13 g, salad  3.47g, dressing .95g, pear canned in light syrup 9.52g and milk 22.59.  She was actually given a pizza pocket, cup of strawberries with sugar and chocolate milk (I allow this treat on her hot lunch days).  She chose not to eat the salad and I am ok with that because she eats lots of veggies at home (thank you for making it available).  As I calculate the carb count I enter 46g for pizza pocket, 27g for the chocolate milk and then I'm left with these strawberries with sugar and there is no carb count to be found.  I can guess at the strawberries and get a pretty accurate number but  I have no clue how much sugar is in said strawberries.  Are they lightly sugared to enhance flavor or is it more like jam in a cup (huge difference on carb counts)?  If I guess wrong then it could wreak havoc on my daughter's blood sugar levels which would then keep her from being in an optimal learning environment.  With either a low BG level or a high one, she can't concentrate and learn like she should.   So you see my dilemma? 

I don't know how to go about making this better but it needs to be better.  We do qualify for free lunch as at the time we are a low income family.  I can't trust the carb counts enough to allow her to eat hot lunch every day (plus a school lunch has higher carb counts than she should eat every day)  I make the sacrifices necessary to pack her lunch from home on most days so that I can control how many carbs she is consuming and know that her insulin is being dosed correctly. 

Thank you for your time in trying to problem solve through this issue.  

Her reply to me is as follows:

Hi, Heidi,

 

Please call me when you have a minute or two. My phone number is xxxxxxxxxxxxx I am sure we can make this situation work better for your daughter. 

The nutrient analysis is done for the general population.  The difference in the carb count in the milk is due to taking into account the district-wide weighted average for all milks consumed (this includes not only the non-fat chocolate but also non-fat and 1% white milk). 

 

I feel the answer is working together (you and I) to make accommodations for your daughter.  One idea is for us to provide individually packed fruit cups for her to have on those "chilled" fruit days which can vary widely. What do you think?

 

Please call!  Thanks....

 

I called her and we had a very pleasant conversation in which we agreed that she would have pre-portioned fruit cups available for Bekah when chilled fruit is on the menu.  In the past I might have been so worked up that I was afraid to call or would have bawled on the phone but I didn't.  I had my moment in the cafeteria (granted I had had very little sleep, a crazy morning and not taken the time to eat anything yet that day) but when I wrote the email and talked on the phone I was very calm yet determined.  I was able to collaborate with the district office to come to an amicable decision.  She is also going to mail me the nutritional menu every month from now on and when there is a nutritional label for something they will be serving she is going to make copies and send those as well.  In the end I got more than I went to the table to bargain for.  I am pleased that it went so well.  I was prepared to put on the bitch hat and get nasty if necessary.  I hope that if you are reading this and having the same or similar issues with your child's school that you will be encouraged to ask for what you want or need.  I was pleasantly surprised that it went as well as it did.   

 

And just because it is fun and food related here is a picture of Josh (my oldest) teaching Bekah how to make dinner (spaghetti).