While we feel deep gratitude for the way that James’ initial type 1 diabetes diagnosis was handled, there were some aspects of diabetes that just felt impossibly hard in the beginning. Our certified diabetes educator (CDE) framed life with diabetes in such a positive way, which was monumentally important to our attitude in those first few days, weeks, months, and even now. Still, giving shots and finger pokes to your child is traumatic. It just is.
One of my first big questions to our CDE as we were being trained was something like, “Okay, so in the best-case scenario, how many times do I have to poke his finger or give him a shot in the course of a day?” I’m sure what that wonderful, insightful CDE recognized in that question was a plea for inflicting the minimum amount of pain. To her great credit, she answered my question precisely and gave me a kind of around-the-clock plan. I appreciate now that she didn’t try to change my perspective about testing or dosing insulin, to convince me that they weren’t that bad. My perspective is in fact different now with years of experience and understanding under my belt. But I felt incredibly grateful that at that moment she met me where I was. She gave me a best-case-scenario plan operating around causing the least amount of pokes and pricks. And it satisfied me and gave me something to strive for.
Since those early days, a lot has changed. James is much older and more independent. His life is more complicated. Testing blood sugar is no longer something we look to avoid. He’s way past minding a simple finger prick or insulin bolus. So I thought it might be helpful to revisit the question of what a day of diabetes looks like for us, around the clock.
(I hope it goes without saying that this is our plan for James. Not only is it personalized to him but to his unique situation as it works for him right now.)
I’ll start in the afternoon, since that’s when our daily prep really begins. When James gets home from school, we take a minute to get all of his devices ready. We charge anything that needs to be plugged in. We make sure that test strip canisters are full and lancets are new. We review the day’s numbers and decide if we are going to make any changes. This is our “Hour of Power,” so to speak.
Next is afternoon snack. This is a period of intense eating for a teenaged boy! We try to use good carb counting skills and just do our best with it.
Dinner is up next. James tests his blood sugar, and we give insulin up front. We also try to finish dinner with at least a few hours to spare before bedtime. This allows us to kind of see how the insulin is working post-dinner and make any adjustments before bedtime.
Before bed we also make his lunch for school. We use a marker to label food items in his lunch so he can bolus accurately and easily.
During the night, we try not to have to do too much. This is where the preparation from the afternoon before helps. Because we’ve been reviewing our numbers and trying hard to be accurate with insulin dosing, we hope we can have stable overnight numbers. Still, because he is a growing kid, and because diabetes can be incredibly unpredictable, we sometimes do need to test his blood sugar overnight and give juice or insulin.
Hopefully our morning starts with in-range blood sugars. Insulin is administered just before showering and getting dressed, giving it a few minutes to work before eating breakfast. James then eats breakfast, grabs his continuous glucose monitor (CGM), his glucometer, and a quick sugar source and stuffs them all into his cargo shorts’ pockets. Then he’s off to school.
At school he usually stays pretty steady. He might get a call from the school nurse if she sees (from his CGM data, transmitted to her phone) that his blood sugar is getting low or very high. His acceptable ranges for school are wider than they are at home, because we want to disrupt his classroom time as little as possible.
At lunch, James now tests his own blood sugar, calculates how many carbs he’ll be eating, and gives himself insulin. (We’ve come a long way!) He has a few more hours at school, and then he comes home and our around-the-clock cycle starts over again!
I suppose in some ways, though our schedule looks very different now than it did at first diagnosis, it has the same goal: managing diabetes in the way that is the least disruptive to life as we want to live it.
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring. Jen and Kim are real moms of kids with type 1 diabetes and have been compensated for their contributions to this site.