El Niño’s First Winter

Happy post-holidays everyone! I originally thought this post would be about dealing with Thanksgiving feasts (which we actually did have, thanks to an American teacher at Carson’s international school) and Christmas treats, which, as we all know, abound at school and everywhere else the entire month of December, wreaking havoc with blood sugars ‘round the world. Here in Holland, we have not only Christmas, but in November, Sinterklaas also comes into town and is notorious for passing out chocolates and cookies, adding to both the fun of the season and also the stress of any parent sending their T1D child to school, knowing that immeasurable amounts of sweets could be handed out on any given day, and hoping that they are able to figure out their insulin intake on their own. Whew!

I decided not to write about all of that. The stress… ahem, I mean, the joy and cheer… of the season doesn’t need to be revisited, and something else came along and knocked that right out of the importance slot of our T1D management.

Now, let me preface this story by saying that Carson rarely gets sick. Occasionally he’ll get a passing fever or a sniffle, but I could count one half of one hand the number of times that an illness has kept him from school. When people talk about whatever is “going around,” I usually feel a (completely obnoxious) frisson of pride, thinking to myself “it won’t be coming around here!” Well, this year I got my just desserts.

Just before Christmas break, Carson’s teacher called to tell me that he had come in from recess not feeling well, perhaps I should come get him. I did, and he came home and slept the rest of the day. What I thought would be gone by morning only got worse, with a terrible cough, headache, stuffed-up nose, the works… just in time for Christmas break.

Then, all of the sudden, I noticed that our morning breakfast/insulin regime, which we’ve pretty much got down pat, was leaving him in the high 200s well after eating. Day one, I thought it was a fluke. Day two, I wondered if maybe the insulin was bad, so I tossed the current Novolog pen and brought out a brand new one. Day three, I started getting frustrated.

Day four, I got up early and gave him his Novolog 30 minutes before he woke up, then tested him constantly to see when it started to take effect, and was shocked and befuddled when, an hour and a half later, his number hadn’t budged. After almost two full hours, it finally began to drop…. slowly. I gave him the breakfast that I’d bolused for, and he shot up to almost 300. Argh!!

I wildly started Googling “slow insulin absorption” and found the standard reasons; site rotation (or lack thereof), scar tissue, temperature, activity level, all the usual suspects, but nothing resonated. I spent hours searching for a reason that his “rapid-acting” insulin, which typically takes a consistent 15-20 minutes to kick in, was now hanging around doing nothing for two hours or more, and then still didn’t seem to be doing a whole lot.

Now, you might be thinking, “duh, of course it was because he was sick!” … and yes, I hoped that’s all it was, but nowhere did I see, or had I ever heard, that the rate of insulin absorption would be affected. I knew that a cold would make his sugars tend to be higher, but this seemed to be something else entirely. I couldn’t picture having to start planning two hours beforehand for him to have something to eat! My mind jumped to the worst case scenario and it was keeping me awake at night with worry.

Luckily, Carson had an appointment with his endocrinologist over the break and I couldn’t wait to hear her thoughts. However, she didn’t seem to have much in the way of explanation. She said to be sure we’re rotating sites (we do, religiously), and that it was possible that hormone changes (he is 12, after all) were causing some inconsistencies. But the snail-like rate of absorption remained a mystery.

Frustrated, I called our trusty endo department at home (under whose care we’ve also remained) but they were at a loss as well. We put the G6 back on so that we could monitor his numbers more closely, and this only caused me more frustration. Not only was it taking forever for the insulin to kick in, he needed so much more than usual. I felt like I did when he had just been diagnosed, before I knew like the back of my hand how much to bolus for just about everything he ate. The smallest amount of carbs would send him skyrocketing, and we were having to wait for what seemed like an endless amount of time after bolusing before he could eat. Because the insulin was working two, three or more hours later than it ever had, and because suddenly I was now taking wild guesses as to how much to give him, often he would drop to scarily low numbers well after he was asleep (and I would have liked to have been as well) and I was up at all hours doing the sleeping bendy-straw juice feed.

Right around the time his cough finally started breaking up and the cold began to lessen, I found a blog post (I was searching every single day for anything about this) by Type 1 fitness queen Christel Oerum (diabetesstrong.com) detailing exactly what we were going through. She had suffered a bad cold and experienced not only high blood sugars but extreme insulin resistance as well, which evidently was a result of the high blood sugars, a frustrating vicious cycle. She even spoke of the terrible lows in the middle of the night, a result of all the insulin she’d given herself to try and bring her numbers down during the day finally catching up. I felt an immense sense of relief (thank you Christel!) and, as the cold lost its grip on Carson’s body, everything started working normally once again and we are back to how things were before the cold hit.

I admit that after this was all over, I felt rather foolish for not putting it down to the cold right off the bat, but hey, in two and a half years it’s never happened! Hopefully any of you who haven’t experienced it can learn from me and not have to spend panicky hours online trying to figure out what’s going on. It was also a friendly reminder from good ol’ Type 1 that you really never have it “down pat.” It can throw something new at you at any given time, and that the learning never stops.

Oh, and I suppose it was a lesson in humility too. My new years resolution is to stop feeling so smug every year when people talk about “what’s going around.” It happens to the best of us.

Cheers to an amazing 2019!

Dove Braunstein is Carson’s mom and Team Captain of Team El Niño, winner of the JDRF 2017 Top Gun Trophy as #1 San Diego Walk Team with over $62,000 raised for T1D Research. Dove, her husband Blake and their son Carson have left the friendly confines of San Diego to live for a year in Europe and she will be sharing their adventures and challenges of managing T1D in their new home country of Holland.