You are now the parent of a type 1 diabetic. Your T1 kiddo comes downstairs for breakfast. They choose cereal. You tell them to dose 20 minutes ahead so the insulin has time to start working before the food. They dose the full amount, around 8 units total, and sit down on the couch to wait.
Suddenly it occurs to you that it's been a few days since you have done a site change. You tell them to grab a site so you can do that, but, when they pull the old site, you notice a lot of blood, insulin, puss, and redness oozing from the pulled site. Two things happened; one, their body was starting to reject the site (which is normal and why we change sites out every couple days), and two, the scar tissue starting to build around the site probably meant that they didn't properly absorb the insulin they had just given themselves to cover breakfast. You are faced with 3 options now.
You replace the site, hope their body absorbed all the insulin it needed for the cereal, and allow them to eat her breakfast.
You decide that most likely they didn't absorb any of the insulin, replace the site, and re-dose for breakfast.
You assume that they probably absorbed some of the insulin, so you re-dose for a portion of the cereal, and they sits down to eat.
Which would you choose?
Think hard about your options and how they can affect the course of the rest of the day.
Consider all options carefully and thoughtfully, because this could be a difference of life or death.
If you aren't feeling much pressure yet, let me expound a little on each of your options. Maybe that will help you make the right decision.
You assumed that their body did absorb the insulin needed to cover the carbs in the breakfast, so, you let them eat and go on about their merry way. An hour later, you notice that they are spiking fast and don't know if this is from the nature of the carbs they ate and will slow down, or, if maybe you should have given more insulin to cover the cereal. Before you know it, they are over 500 and texting you from school that they have a headache and stomachache. You tell them to give a correction, but it's not working fast enough. They have a math test in an hour and you know they are way too high to concentrate, so, you consider getting them from school and handling the situation from home.
You assumed that none of the insulin was absorbed and you tell them to re-dose for the carbs all over again. They do, they sit down to eat, and about 30 minutes into it, you realize they are dropping really fast. You don't know if the new site is working too well, or if maybe you just need to wait another 10 minutes to see the cereal start to slow the drop down. You keep watching the Dexcom and notice that the drop isn't slowing. You text them at school frantic because you realize that they could have double the insulin on board to cover cereal that you had them essentially dose twice for. They tell you they feel sleepy and sick to their stomach and just want to lay their head down on their desk. You race to the school, trying to call the office or get hold of someone who can go to them and make sure they aren't going to seize from the amount of insulin on board. You can't get there fast enough. You are speeding, you pass a cop, they turn around and flip their lights on. Do you stop? Do you keep going? Will they understand the reason why you are going 50 in a 25 to get to your child at school? There's no time. Nobody is answering at the school. You are the only person that knows what's happening and the dangers.
You tried to make an educated guess on how much insulin was absorbed and how much wasn't. There is literally no way to know how much went in, or came back out, and this option can either lead to the same highs or lows from options A and B.
In this situation, is there a right answer? Maybe. You never know until you make your decision and see the repercussions unfold in front of you.
Every day parents of type 1 diabetics make decisions that will ultimately affect their children's lives. Consider something so simple as breakfast and how it can affect the entire course of the rest of their day. You are damned if you do, and damned if you don't. If you choose wrong, they could feel like shit for an entire day, or, they could simply lose their life. I know that might seem like an exaggeration, but, ask any of us who have seen our children go from completely alert and talking to passed out on the floor unresponsive if that's exaggerating. It's not. We don't sugar coat this stuff just for shits and giggles y'all. We do it to spread awareness and end the stigma and jokes surrounding diabetes. This is our reality.
If you got to the end of this, congrats. Tomorrow's blog will be part 2 where I explain to you the choice I made, as this situation happened to Hannah this very morning.