## Saturday, March 27, 2010

### The Golden InCA Triangle and Nonsensical Mathematics

The Golden InCA Triangle:

Legend has it that there is a golden triangle buried deep in the rain forests of Peru....  OK, that I made up.
It's not a real "triangle" in the sense that we can go all "Tomb Raider" and chase after it, it's more of a conceptual representation of the relationship between Insulin, Carbohydrates, and Activity.

- Three Sides to the Story (My D club friends can skip to my math rant, you know this part already):

Side 1: Carb Intake - Insulin Demand
The more Carbs taken in, the more insulin that is required to get the resulting glucose from the blood stream to the cells to fuel them.

Side 2: Activity - Insulin Demand (one way or the other)
This can go one of two ways.  In most cases activity can lower blood sugar and therefore reduce the amount of insulin needed however, adrenaline can bring blood sugars up.  Therefore, either way, activity levels impact insulin demand.

Side 3: Activity Level - Carb Needs
Food to fuel the body is probably the most commonly understood side amongst diabetics and non-diabetics.  It's a matter of biology, the body needs fuel to do work - plain and simple.

So, the three points on the InCA Triangle are: Insulin, Carbohydrates, and Activity.
Now this is a fairly watered down version of what really goes on in all of our bodies (yes all of them, regardless of how you get your insulin).  There are numerous factors at play, but these are three of the four main areas and they are the ones that we can directly measure and influence.  The fourth one, the one we really can't do much about and especially wreaks havoc in kids, is physiology (ex. stress, illness, bodily changes, etc.).  There are a staggering number of things happening in the body at any given time, and we don't fully understand it all.  Quite simply, we don't know what we don't know.  So, we deal with what we do know, and we go through our days with these three things in the forefront of our minds, guiding our plans, and filtering our post analysis.

Nonsensical Mathematics:

T1 management styles can vary depending on how the diet is set up, insulin regimen, age, and lifestyle.  In our case, we have chosen to maintain a healthy but non-diabetes centered diet.  We manage to a prescribed target range of 6-12 mmol/L with injections of a fast-acting insulin at meals determined by carb ratios, a graduated scale for correction of highs with a fast-acting insulin, and a fixed amount of long-lasting/non-peaking insulin for his basil (aka the once a day shot).  That last one is a different insulin than the meal time / correction insulin, and furthermore can not be mixed or share recent injection sites with the other. Age is 4 1/2, and lifestyle is, for lack of a better definition, 4 1/2.

The meal ratios and amount of long-lasting insulin have been set up and adjusted over time to achieve the closest to normal glucose patterns possible (still not close to perfect, but pretty good).  Monitoring is constant and adjustments are made as needed, but Jonathan's ratios currently are: Breakfast 1:13, Lunch 1:18, and Dinner 1:20 which is 1 unit of insulin for every x grams of carbohydrates minus fibre.  It is given to the lower 1/2 unit, meaning if the ratio results in 3.7 units, he will get 3.5 units since his pen is graduated in 1/2 units (this is where some pumpers have an advantage, they have smaller increments).  We do have a bit of a trick up our sleeve though.... we usually adjust the amount of carbs slightly to get to a full half unit up or down ;)

For the most part lately (but there are always exceptions), his breakfast and lunch fasting numbers have been in his target range.  Dinner, not as consistently, but his afternoons are more variable and we see him come in throughout his range and sometimes above.  We often talk with the clinic about increasing his lunch insulin, and we may be doing that soon, but the worry is though that we don't want to put him at too much risk of lows.  As a side note - there is always risk, we all know that.  Diabetes management is just as much about risk management as anything else, but I digress (as I usually tend to do).

Although his dinner fasting number is not consistent, I'll still use this meal as my example because we have the most post-meal observation time here.

In a perfect world... ok well in a perfect world we wouldn't be having this discussion....  In a diabetics' perfect world, things would add up, X carbs plus Y insulin at known activity would equal in range glucose levels.  But sometimes, and sometimes can feel like a lot of the time, 1+2+3=9.
Nine!? Nine you say!? That's higher than it should be!  Yep, it shouldn't be that high, yet it is.  And so it can be with glucose.  In my previous post and attached comment, I made mention of certain foods.  There are some foods that seem to be unpredictable.  I have yet to find a good way to nail it down to specific cause and effect relationships, but one thing I do know is the more that is unknown about the food, the more likely it is that glucose will go out of whack.  The top three offenders I've heard over and over are: Chinese food, pizza, and pasta.

I have yet to order Chinese food and see it arrive with a nutritional label on each item.  There are websites and books and pamphlets and such that list the nutritional values of these foods, but if you've ever had sweet and sour chicken balls at more than one place, then you know there is no way a one-size-fits-all exists for the data on those balls.  Similarly with pizza, recipes vary from store to store, that's why we have favourites and are picky about who we call, and I don't recall ever seeing a pizza cut into equally divided pieces, 15g/slice?  Maybe.  Pasta is not much better.  If we make it at home it's actually not any more of an issue than any other food, but at a restaurant....  anyone have a dart board?  An Italian friend of mine recommended once that to cut a bitter tasting meat sauce, add white sugar until it's right.  Pure white sugar!  Although I'll admit, I didn't have a concern over that last year.

There are two other food factors that no one seems to have a good handle on how exactly they fit into the equation, fat and glycemic index, so I'm kind of keeping those in the background for now only paying them a little attention.

Variability is one factor and is generally accepted as a truth.  The other biggie that I can't shake, is time or rather time-delay.  Asking nurses and dieticians, I'm told that food is digested and glucose is in the blood stream within less than 4 hours (more like less than 2 hours).  A hard and fast number no, and there will be differences between foods, but 4 hours is the supposed point of stability because not only have the carbs been absorbed, that's also about how long it takes his bolus insulin to fully run it's course.  So, the theory is that by the time 4 hours have passed, all of the carbs have been converted to sugar, moved to the blood stream, his insulin has run it's course and carried glucose away to hungry cells.

Then why is it, even when the meal is an established staple in our house and not some wildly random variable, that he can shoot up for checks beyond the 4 hours?  I've seen dinners in the single digits, with +2hr and +4hr checks also being in the single digits only to go into the teens at +6 or +8 hours.
My high school math teacher always asked me to show my proofs.  They wanted to know how I determined that x=2.  Well, it looked good on paper, but sometimes 1+2+3 really does equal 9.  This is where the teacher-student argument would ensue, but I'm sure we could come to some sort of compromise.  How about 1+2+3x=9?  On paper, we could show that x=2, but in D-world, the x is elusive.  X is why we scratch our heads and wonder what we did wrong.  X is why we grab our calculators and re-add, rice + milk + strawberries + Oreos = C, C/r = ? units...  X is why we keep asking why.  There is surely more than one X too.

Scary stuff if you dwell on it too long.  So many random variables out to thwart our best efforts.  As we keep the monster at bay with our tools and knowledge, all we can really do is focus on what we know and what we can control.  How much of and what we eat, how much insulin we inject, and how much and what kinds of activities we do.  Beyond that, it's in someone God's  hands.  Fortunately we have three quarters of the game in our pocket, and in my fuzzy math that's about 90-95% of the battle.  Those are pretty good odds.  Being the control freak that I can be sometimes, I remain unsettled with less than 100%, but that keeps me on my toes and ever vigilant for my child.  I just hope that my attention, determination, and focus can help give him the healthy life he deserves.

PS:  I've been poking along at this throughout the day, and at the same time catching up on some others blogs too.  I feel I should admit that I write today as "calm, cool, collected Dad", and not "frustrated, discouraged Dad".  I can definitely appreciate the frustration that comes from beating back the double digits and the disappointment that there is still no cure yet, but my thoughts today are more in the "at peace with it for the time being" vein.

## Thursday, March 25, 2010

### Pizza assault

My last few posts have been a bit of history, but today some current events.  Anyone that knows me knows that I can, on occasion, have a bit of a short fuse.  Be it a combination of a few nights of 2am BG checks mixed with a generous amount of caffeine today and some completely out-to-lunch customers, or simply the planets not aligned in my celestial house, or something a little more realistic in between.  Whatever the case, I was on a hair trigger today.

Jonathan seemed to have a similar day.  Now, I did wake up in a fairly good mood and I believe I left the house in a pleasant demeanor, but there is still the possibility that my bad vibes wore off on the little guy.  Then again, as I look at his numbers for the last 24 hours I start to wonder if there is a connection.

He had good numbers through the night.  Yesterday he was 6.0 at dinner + 4 hours which was a bit of a drop from his bed-time check hence the "2am" (or 2:22 after hitting the snooze button twice and ticking off the wife) but that was 12.6 so I rested easy the remainder of the night.  Breakfast was 8.2 (this is all mmol/L btw) which is nice to see, but today is an occasion and that's where things seem to have started to go off track.

About once every 5-6 weeks the school does a "pizza day".  The full day students get pizza, cinnamon sticks, and juice for lunch (depending if and what you order).  I have no clue how many carbs are in a "cinnamon stick", but I have about a half a year before we get there.  The morning kids however, aka Jonathan, can order a slice of pizza for AM snack.  In keeping with our "let the kid be a kid" philosophy, we let him participate in pizza day since it's not frequent thing.  When we have pizza, we usually count it at 15g-carb and this works ok.  A "slice" as we all know can vary wildly, but back to my point.

Since "pizza day" for Jonathan happens about an hour later than normal snack (and an hour closer to lunch), we send a note in his lunch log to reduce corrections by 1 unit since we don't want a slice of pizza eaten 45 minutes or so earlier to trick the nurse into giving him more insulin than he needs.  Again, this is all rough estimation, but has been successful previously.  His lunch BG was 18.0, so his insulin was 2.5+1-1=2.5 units.  When we checked him at dinner he was 17.6, so it may be safe to say he was high all afternoon.

Here's where it gets weird.  Jonathan is usually a really laid back and loving/lovable guy.  He's the sweetest kid, but not today.  When I arrived at latchkey to pick him up, he was sitting down and Miss. Deb informed me that Jonathan had something to tell me.  Jonathan immediately started crying, so I took him aside and tried to get him to talk about what had happened.  I managed to gather that he had hurt one of his closest friends.  He had thrown a dinky car in his face, and roughed him up a bit on the carpet.  I was really surprised.  Jonathan is not an aggressive kid, at least not that we've observed so far, so this brought two questions to mind.  The non-D question was, is this the beginning of some sort of behaviour that we need to get a handle on now (and I guess regardless of the answer to the second question, that would be a yes)?  But, the D question I pose now is, can/do high BGs prompt or exacerbate aggressive tendencies?

It's the second question I'm wondering if anyone out there has some insight on.  With rare exception, I am not one to accept inappropriate behaviour and excuse it on the basis of "an influencing factor".  It's my opinion that if highs = aggression that he needs to learn how to deal with it properly (I can't throw dinky cars at my customers, as much as I'd sometimes like to).  I'm just trying to find out if there could be a link between the two to help me better understand the relationship and help him learn to manage that.

Any thoughts?

## Wednesday, March 24, 2010

### Our education in attending school (and a smidge of proof that things are ok)

Being diagnosed with Type 1 Diabetes was a huge event in Jonathan's life.  It was, beyond a month prior, totally unexpected and it changed all our lives forever.  Yet another huge event followed almost immediately after.  I'll give fair warning now, I am quite biased in the telling of this story and I have some very strong feelings about what transpired.  In fairness to all involved I would like to set the record straight in advance: It is not my intent to attack anyone personally.  Furthermore, my biggest beef is with a flawed system, not necessarily any one individual within it.  I've really toned this down since I first wrote a draft for the local paper.

School was a hot topic during our week at the hospital because we all knew that day was approaching, and fast!  There was some confusion at first regarding how his school-day care was going to be handled.  Initially we were told that a nurse would visit him at lunch time to check his blood glucose and administer his insulin; this was a huge relief.  However, shortly thereafter we were told that this would not happen because his school day technically ended before lunch and the program that provides care at school is only available during school hours.  Needless to say, I freaked.

I lost track of how many people I called and how many times I called them, but it didn't take long before I felt like I was getting the run around.  I met with his teacher, I met with his principal, I called the school board, I called the city, I called provincial offices, I called Canadian Diabetes Association, I called Juvenile Diabetes Research Foundation, I called Community Care Access Center, I called the Health Unit, I called Diabetes in Action, I called a whole slew of people and was continually referred from one person to the next.  No one seemed to know how to handle our situation.  It almost seemed like he was the only 4 year old diabetic in a school.

Even though his teacher was willing to assist Jonathan with his testing, this is forbidden by board policy.  Even though there was staff at the school willing to test him and administer injections on a personal basis and not as a function of their job, they are not permitted to and could have faced severe penalties (likely termination of employment).  It was very discouraging trying to work through the school system to establish support for our little guy.  Phone calls to the superintendent of education to request a discussion about the related policies were only returned by an administrative assistant who was relaying messages which were along the lines of, "no, nothing can be done" and "the matter is not up for discussion".  I was shocked and dismayed that our school board would turn it's back on a student in need.

Both my wife and I work outside the home and too far away from the school to travel there everyday at lunch, and the costs for contracting someone privately are outright prohibitive.  The option of not sending him to school for kindergarten was on the table, as undesirable as it was.
Everyone wanted the best for Jonathan and everyone, with a few exceptions, seemed genuinely sympathetic to his situation, but it seemed that no one was able to help him.  The school staff was inexperienced with diabetic students with the exception of one that was diagnosed at an older age and able to self manage, but they had never dealt with anyone so young.  The principal, while only able to follow policy to the letter, reached out to her contacts to see what was being done at other schools, but there was not a solution out there either.  Fortunately, out of everyone we contacted, we had reached a few key people that were able to come up with a creative solution that satisfied Jonathan's needs and respected the boundaries of the various organizations' policies and mandates.  Finally, after about 2 weeks of chasing people down, we were able to solve the issue of lunch testing and insulin.  This was a big step in that Jonathan would be able to attend school.

We still had the issue however of testing during class time.  Despite our best efforts to start off his day with an insulin / carbohydrate combination that will carry him safely to lunch, there is always the possibility that he may face a dangerous low or high.  And while the kindergarten teachers and a few other staff have been trained on how to detect symptoms by observation, this is highly inaccurate and in some cases not even possible.  We provided glucose meters and test strips to the school, but they simply are not allowed to use them.  The best we could do is "when in doubt, give a snack" and the nurse will correct at lunch if necessary.

Fortunately, the on-site after-school program isn't bound by school board policies in this matter.  They are a separate operating entity within the school facility and they are allowed to test him.  So in the afternoon, he can be tested whenever necessary, but the morning was still a gap.  Thank God the school policies do not prohibit the school and latchkey staff from caring and cooperating.  While daily testing is not practical, Jonathan is allowed to visit the latchkey office in the morning should the school staff feel that he needs to be tested.

Jonathan is loving school and we are so happy that he wasn't prevented from being a normal student. The last seven months have been stressful to say the least, but the reward had been a child that gets to live an almost normal life.

This is, from what we can tell, about as good as it gets in the school environment.  It's not perfect, but it's working.  It was hell getting there, and there needs to be a better standard put in place so that new diabetic students and their families don't have to all go through this.

Despite our very rocky start, I do have to give a big hand to everyone that is involved in Jonathan's care.  The only real evidence we have that our set-up is working is that he is happy and healthy and being a kid.  We collect all of our data, not every day is consistent, but we see positive trends and with the team's hard work and diligence his A1c went from 11.8% at diagnosis, to 9.4% at +60 days, to 9.0% 90 days later.  We're told that 9.0 is a gold star for a 4 year old but all of us are looking to head for 8.5% by May.

## Tuesday, March 23, 2010

### ... And then there was light.

Our first week as D parents, like many, was spent in the hospital. Being admitted in the early morning hours of a Saturday meant that clinic staff would first visit Jonathan on Monday, but there was always a nurse just a few meters away and someone was coming in to check on him regularly and all hours. His new paediatrician almost seemed to live there and our family doctor came in to visit him too (yes on the weekend!).

We also got an unexpected surprise: As it turns out, my mother's cousin's son also has Type 1 Diabetes. She and her family were up to see us that very first afternoon in the hospital with a care package and a lot of encouragement. I could never adequately express my gratitude to them for their compassion and generosity as they helped us to get Jonathan started on his journey and as they have been there whenever we needed advice or insight.

One of the first things we learned was that there was a veritable army of people that had Jonathan's back. Doctors, nurses, diabetes educators, dieticians, social workers, children's life services, and the list goes on. They are also there for us too. Whether it was intentional or not, they made sure we never felt like we were going to have to face this alone. I took great comfort, and still do, in the fact that we have access to so many experts, a great team to help us manage this disease.

Early on, we discussed treatment options. Basically, what it came down to was that we had two insulin regimens to choose from - we were told he probably wouldn't be pumping right away. One option had an extra injection but also allowed a little more flexibility, so we chose that one because I had already made up my mind that while diabetes would from now on be in the forefront of our thoughts and plans, we were going to minimize it's impact to our son's life. What this means is that while keeping his health and well-being our number one priority, all things being equal we were going to choose options that differed as little as possible from how his life would have been without diabetes.

And so it was on. The first couple days in hospital the nurses performed the glucose tests and administered the injections. We watched, sometimes with great difficulty, as they had to pin him down while he fought back. What 4 year old kid wants to have needles anyway? This was all new and frightening to him. He didn't understand what was going on, we were just barely scratching the surface ourselves.

We got a crash course in biology, endocrinology, pharmacology, diabetes, and how Jonathan's life was going to be. A lot of information to take in over a short period of time but we were extremely fortunate to have a top notch team of diabetes educators without whom I'd probably have lost my mind. Just as fortunate, we still have access to this team as they help us manage by reviewing our data and consulting on dose changes.

They had us quickly put into practice what we had learned. It was tough at first. I was really hesitant to stick a needle into my beautiful little guy, but knowing what would happen if I didn't was a good motivator. The first couple kicks at the can were, in my opinion, nothing short of a spectacular blunder. I recall vividly the first injection I gave him was in his right leg and he was squirming so much that as I slowly approached with the pen, he moved and the needle scratched him. I pulled back and then quickly inserted the needle into his skin, pushed the button, and the pulled right back out only to see the insulin ooze out reminding me that I had forgotten the ten count. I had no choice, I had to let it go. There's no way to determine how much came out, so I couldn't try again until later.

Over the next few days, as we continued to work with the team at the hospital, we slowly became a little more comfortable, a little more capable, and ever so slightly more confident. Aside from the finger pokes and injections, Jonathan was really starting to like this whole thing. He had his meals served to him in bed. He had a TV and DVD player in his room and could watch whatever he wanted. He had many pretty ladies visiting him all the time. He had access to a very large toy room and people that would play with him and do arts and crafts while mom and I were busy learning as much as we could. It was probably the best vacation he ever had. I can't say enough good things about the hospital and staff. They went out of their way to turn our nightmare into a positive and beneficial experience. Now, I'm not saying that diabetes isn't still a horrible thing, it's awful, but my point is that they did everything humanly possible and then some to make a horrible situation as good as possible.

The day was coming. Time had flown by and it was almost time for him to be discharged. There was some back and forth as to when we'd actually leave though because we had one more challenge coming upon us: Mom was having surgery and would be laid up for a little while. We had been through a more aggressive surgery a year earlier and somewhat knew what to expect, but the question now was how best to deal with diabetes and recovery. Our son's paediatrician was very open to working with us on what was best for the family. In the end it was decided that mom and son would be discharged at the same time. I remember the final hours being very chaotic and all kinds of last minute changes and unknowns, at least from my perspective since I usually plan everything out to the Nth degree. But we sailed relatively smoothly out of the hospital and back into the real world.

The mass confusion I brought upon myself as we prepared to leave the hospital I think helped to shield my mind from the potentially paralyzing fear of re-entering the world with our new-found responsibilities. It reminded me of the first time I drove by myself. I had just gotten my license and my mother was on the phone and was going to be a while so she told me to drive myself to work instead of waiting for a ride. It was only a few blocks but I was so close to being late I didn't even have time to think about the responsibility I had just assumed for the first time, but about half way through my shift I realized I was going to have to do it again. In similar fashion, I left the hospital with so much on my mind that I completely lost sight of the fact that we were going to, for the first time, be taking care of our son without the safety net of being at the hospital.
I seem to recall the first night going ok. Over the next few days I was constantly testing his blood to see what his glucose levels were and there were corrections in both directions. I slept very little those first few days, but the one thing I had on my side was time. I had previously scheduled vacation time to take care of my wife after her surgery so work was not a factor in this first week. Somehow I managed to maintain my sanity despite it being a holiday weekend and the clinic being closed. His doctor gave me her pager number and the number for the paeds desk - thankfully there was no cause to use them.

After getting through Labour Day, I must have called the clinic at least twice a day to let them know what was going on and ask if I should be changing anything. I had a really hard time gauging his blood sugar based on his actions and behaviour, and I still do. Occasionally his highs and lows will line up with mild symptoms, but more often than not I find a normal level when he's acting strangely and sometimes a high or low when he's being perfectly normal. During this first week at home though I found this especially frustrating but fortunately we are able to test him as often as necessary. I can not even imagine what I would have done 10 or 20 years ago.

Out of everything, I'd have to say that home life was the easiest adjustment for all of us. So many of the variables are in our control there and we can react quickly to changes. Being at restaurants and other people's houses is still a challenge and probably always will be. It's also at this point that I have to admit that I think we've been really lucky in that things haven't been as wild as some other stories we've heard. From some of the stories I've come across, I've only been able to conclude that Jonathan's case is one of the more easily managed ones although as we all know, things can change in an instant.

## Monday, March 22, 2010

### In the beginning, there was darkness...

I've been asked a number of times, "How did you know?" or "What made you get him tested?". Every time someone asks, I think back and try to pin-point an event or issue that could possibly have been the first sign. I guess I'll never really know for sure exactly when his little immune system turned on his pancreas, but in hind sight there are a few things I can't ignore.

Last Spring (2009), I noticed that he was drinking a lot. He was always thirsty, and at meal time he would easily pound back at least double his usual fluid intake. I didn't really think much of it at the time since for years I have gone through spurts where I'm more thirsty than normal and drink a lot; I've gone through as much as 6-7L of water in a work day and I'm in an office. After a few weeks, his thirst levelled out again and it was all but forgotten. Again in August he started with the unusually high thirst. But this time it was extreme. He was even getting up on his own in the middle of the night to get a drink of water in the bathroom. At the same time, just as we were considering ditching the night-time underpants since he was starting to wake up dry on a regular basis, he started filling at least one and sometimes two pull-ups a night.

After about two weeks of extra drinking and really excessive night time wetting, I started to worry. The lady that took care of him while we were at work began expressing concerns too. Being diabetic herself, she was more aware of the warning signs. I was in denial, and started thinking back to the spring; this is a phase and it'll pass. The third week was the kicker. Jonathan was just not himself, and as much as I didn't want to acknowledge it, I could no longer carry on believing that he was just a little under the weather. Too many people had noted the changes in his demeanour and threw up the red flags. No mater what I was afraid to face, I knew one thing, I couldn't put him at risk by just waiting and hoping.

First thing Monday morning I called our family doctor's office to schedule an appointment. Thursday was the soonest he could be seen. I'm usually a little nervous going to the doctor since I know I'm there because something isn't right. This time was different, I was a mess. As much as I wanted to pretend it wasn't real, I already knew deep down what I was going to find out very soon.

Things happened rather quickly. One of the great things about our family doctor is that the facility she works out of, housing a few other doctors, also has an on-site lab. Jonathan gave up a urine sample while we were waiting to see the doctor and by the time we were in her exam room, she had results. The "sugar levels" in his urine were high. She told us that this could be indicating diabetes, but she would get blood work done to get more information. We were given the lab req. and told to come back in a week. I scheduled his next appointment and we went back across the hall, submitted the req. and waited our turn. He ran laps around the waiting room, which wasn't odd for him, but as a frightening reminder of what we were investigating he would stop every few times around and say he was tired. He was a contradiction, active as ever but complaining of fatigue. We were called into the lab and his blood was drawn; now the wait.
I don't remember much about the evening after that appointment. Either nothing remarkable occurred, or I've blocked it from my consciousness. The following day however, I will remember forever.

That Friday we were set to go out and celebrate our anniversary, 9 years two days earlier. Everything was planned in advance, the dinner, someone to watch the kids, it was going to be a nice evening. Per our usual routine, I picked the kids up from school and headed home to make dinner for them while we waited for mom to get home. When I walked in the kitchen I noticed a message on the machine. I listened to the nurse from our doctor's office state that Jonathan's blood work had come back and the doctor wanted to see him today. "Today?" I thought. It's 5:10, this message was from early in the morning. I knew the doctors office was surely closed buy now, but I tried calling anyway. I got the recorded message I was expecting and jotted down the after-hours numbers. One of the numbers was for a nurses line. As part of the family health group we joined, we have access to an after hours nursing service to call for advice.

I explained to her what was going on and the message I had just received. She told me that we shouldn't wait until Monday, we had two options. Take him to the ER, or the weekend clinic opened at 6am. I thought to myself, what's the difference between waiting until midnight to be seen in the ER or getting to the clinic first and being seen only 6 hours later. We discussed it briefly and I decided that he would be better off not going to the ER, for a lot of reasons, and 6 hours was not a very long time. The nurse on the phone didn't specifically agree or disagree with my plan, but reminded me that if I changed my mind I could go to the ER later.

I finished making dinner for the kids and sat them down to eat. As I paced, continuing to debate whether or not to go to the ER, the phone rang. Another nurse from the after-hours line called and told me that I should not wait. Based on the doctor wanting to see him so soon, it should be considered urgent enough to take him to emergency. I let them finish their dinner. My wife and the sitter arrived at about the same time and we took him to the hospital, went through the initial screening and then waited. I was on the verge of cracking the whole time. I'd like to think that most of the time I have it pretty much together, but when it comes to the kids I don't have much emotional control.

He was getting bored, but also tired. It was close to his bed time, so we tried to relax him and encourage him to sleep. We soon realized that we were likely not going home too soon, so we made a few phone calls to have pyjamas and pull-ups brought over. I'm not sure exactly what time we were called back to the screening station, maybe around 9:30 or so, but I vaguely remember I wasn't the one to take him over there. When my wife came back with him she told me they checked his blood glucose and it was "21" (mmol/L I'd learn later / or about "378" in other units). A lady sitting near us was shocked. A relative of hers, I can't remember exactly who she said, is diabetic and that is a really high number (I know now some come in much much higher). I think that was about the time I really broke down.

It wasn't long after that we were escorted into what I call "the bed room", which is basically rows of curtained stalls with beds and some monitoring equipment, a mini hospital room of sorts. Vitals were taken, more blood was drawn, and we waited some more. It seemed like an eternity on a high-speed slow-motion roller coaster. Finally, at about 2am or so we met a doctor, who we would come to know to be a wonderful paediatrician, that had come to tell us what we were sure we already knew. Our little guy has Type 1 Diabetes and his life is now forever changed.

## Sunday, March 21, 2010

### This is a first

I'll admit it, despite the fact that it may be quite obvious, I am a first time blogger and this is my first blog.

I'm doing this because of something very important that has happened to our family, to our son...

Jonathan was diagnosed with Type 1 Diabetes, turned 4, and started school.... all in less that 3 weeks. A lot has happened in the 6 1/2 months since, and there is surely more to come.

I had seriously considered sitting down and writing a book at the end of the first year, and I still might, but when I really considered my motivations for doing so I realized that may not be the best medium for me. I came across some fellow T1 parents' blogs and thought I'd give this a whirl.

I am one of many thousands of parents of a diabetic child, and like all those others I have stories to share; perhaps just as much for me as for anyone else. Hopefully this does someone some good.