Transcript
amandacberg: Hi all, okay so today we're gonna dive into like our unique management styles and give some like practical explanations and just do you know like hyper specifics of timing of insulin and our thought processes and Um, like the reflection of blood sugars, because I don't know about all of you, but I feel like that's how we all learn the best is listening to other people's specific experiences and like their thought processes and then applying it to your own life. And like, we just don't get that from the end of his office. you know
Raquel: Yep, exactly. So definitely not medical advice, but I think it's really helpful to hear how other people manage and so you can experiment with what works for you.
amandacberg: Yes, absolutely.
amandacberg: Yeah, so we'll go through a few um ah few like specific scenarios each. Do you want to start, Raquel? Do you have something in mind?
Raquel: I guess the most recent one that I got a lot of questions about was when Kevin and I went to the San Diego County Fair recently, which was really, really fun. And of course, more questions come when you're eating a lot of foods that are really difficult. Obviously, a lot of high carb foods and then also high fat foods and those two things combined can be really challenging. um And I think something that just isn't talked about enough in the space is how much timing matters for food and timing of insulin and food together. Um, so that's a fun day.
Raquel: Like I was going there more to eat than anything else, honestly, cause I'm not a big like roller coaster reason or rides.
amandacberg: Yeah.
Raquel: And so it wasn't in my mind that I was going to like say no to something that I wanted to try. Um, but I did pay close attention to the timing of it all. For example, we. got in to the fair and immediately I was like I can't remember exactly probably 90 and then trending down to 80 and just like slowly dropping and I could see that and so that was my immediate signal to like okay I know I'm gonna want this dole whip at some point it's right here I'm gonna grab it right now and we're gonna be walking probably for the next at least 20 minutes probably longer um depending on if we stop and do other activities so let's just grab it so I did
Raquel: and I didn't give much insulin for it at all and I kept going down and then eventually as soon as I started trending up and enough to where I could see that I was really gonna spike I gave a little bit of insulin because I know that in my body when I get insulin on board and I'm ah walking or working out in some capacity it's going to almost speed up the effect the efficiency of the insulin and so I didn't need that much so I probably gave myself maybe 0 .5 or a unit
amandacberg: yeah
Raquel: Uh, when really that whole thing of dole whip, I mean, Kevin and I shared it, but I probably had at least 20 or 30 carbs worth. Um, and it was fine. And then I started studying out.
amandacberg: And how many units would you typically take if you were going to be eating 30 grams of like a really sugary food like that?
Raquel: Yeah.
Raquel: Yeah. My car ratios usually depending on the time of day one to seven right now. So it would have required at least a few units.
amandacberg: Okay. Yep.
Raquel: Um,
amandacberg: That's a significant difference.
Raquel: yeah huge difference
amandacberg: And that's something that's, yeah. And that's something that's not discussed, but it's so important is like figuring out your, or your child's unique reaction to fresh insulin plus activity, whether it be walking, climbing, sprinting, you know, like whatever every, it's like for Hattie.
Raquel: Yeah,
amandacberg: depending on her activity, her blood sugars react completely differently.
Raquel: huge difference.
amandacberg: So I can give her fresh insulin and if we're just walking leisurely, that's not necessarily going to tank her. I will need to give her a little bit less than usual. But if I give her fresh insulin and then dad comes home and they're playing spider and chasing each other for 40 minutes up and down the hallway, like she's tanking.
Raquel: Yeah.
amandacberg: I mean, as in drops of like 50 every five minutes.
Raquel: and
Raquel: yeah
amandacberg: So that's when it's like, okay, I'm going to start with like 10 % of the dose that I typically would.
Raquel: Exactly, which I think is where all the frustration comes from is these people get ratios from their doctor or the settings they have set by their doctor in their pump and they just think that they are for all the time for every situation and there's so much variability. um So of course it's going to cause frustration if no matter when you're eating that dole whip you're giving 30 Carbs where like it's not always gonna be that depending on what's going on and it might be more and depending on other things. So um Yeah, and then I'm trying to think what else we got at one point we got like some chicken some things I wanted some protein and then
amandacberg: Yeah.
Raquel: um And that was intentional, right, getting some protein in my system, so I'm not only having high sugar fat things.
amandacberg: Yeah.
Raquel: um But then I was dropping again later, and that's when we got fried Oreos. So, you know, it was just kind of like a go with the flow situation. And luckily, I have a partner that's really understanding of that. And if he would have been like, Oh, I want the Oreos right now when I was 180, I probably wouldn't have said no I would have been like okay and then I just give the insulin for it and then I'm walking and I know I'm gonna go back down so I never went over 200 but it was really interesting as soon as we got back in the car and I wasn't sweating anymore and I wasn't walking anymore. I started to spike.
amandacberg: Yes.
Raquel: So it's like all the high fat foods. Number one, the timing, right? It's a delayed spike. So it started to catch up with me, but also there is just something about the stillness. ah My friend Tate and I always talk about this too. Like we will go on walks together a lot if our blood sugars are high. She's type one as well. um But it's kind of a joke that like, okay, it's coming down. And then as soon as we stop walking, it starts biking again, right? And that is so real. So at that point, I gave a few units of insulin to kind of catch up for the carbs that I missed when I didn't need the insulin, if that makes sense.
amandacberg: Thanks.
Raquel: So that might be hard to grasp, but it's like, it's just all about timing and paying attention, which for me has become intuitive. It might sound like a lot if you're new to this and it's like, oh my God, I'd be glued to my blood sugars all the time. But it's actually more freeing to me to allow myself to do the things I want when I want to do them and just kind of go with the flow of what my blood sugars need in that moment.
amandacberg: Yeah, I think that's a ah perfect way to explain it. And that's where we got to. And when we were not there and it did feel like I was forever chained to counting every last carb and pre -ball thing and forcing her to sit and wait, that's when like my mental health was suffering the worst and when I felt the most trapped and the most depressed too, because it was like,
Raquel: Yep.
amandacberg: this that That is not a normal way of life. That is true restriction. That is true disability. But there are management styles that open up life with diabetes so it does not feel like true restriction and true disability.
Raquel: Yes.
amandacberg: You know, and so it's interesting as you're like explaining all of this, I'm thinking to myself, how did I get there? And it is because of the scale.
Raquel: Mm.
amandacberg: I'm so obsessed with it.
Raquel: Yeah.
amandacberg: um We'll link it in the show notes for those of you who don't know what we're talking about, but it's a food scale and you weigh whatever food, using food codes, and based on the weight, it tells you how many grams of carbs are in that exact amount of food that's on the scale. And that is what changed everything for me. Because once I did that, like four months, every single time we ate food at home, I used the scale. And anytime we went out, I would Google and like a lot of the fast food places and some of the bigger chain restaurants and stuff, they have true carb counts. So if you do it enough, it becomes just like part of your brain, you know?
Raquel: Yeah.
amandacberg: But, um, and then like googling stuff, like a basic chocolate chip cookie has 10 grams of carbs.
Raquel: Great.
amandacberg: Well, you figure out after three trials and they're dosing, but it's a, that's a small chocolate chip cookie, not a big hunk of chocolate chip cookie. Right. So whatever. So I'm just thinking like you have had 20, how many years now, three, four.
Raquel: Almost 23, yeah.
amandacberg: thirty years of doing this so if any of you are new or if any of you have not ever used a food scale and you've only ever used like measuring cups and stuff that's that's hard you know um and using a food scale really helps you eyeball things and feel super confident in your guessing of carb counting and in the world
Raquel: Yeah, it's so interesting.
amandacberg: and
Raquel: I've never thought about the connection because I know you talk about the scale a lot and I've never used a scale personally. I'm not really sure if my family ever did, but we did have like a card counting book from when I was first diagnosed that we would carry everywhere with us. And it had a lot of those basic foods too. Like just like you can Google things so easily now, but that wasn't possible at the time. Um, and my family was really good at relaying that information to me. So I feel like I had years of practice, almost like you did with the scale, but like as a kid, from the kid's perspective, it was like, Oh yeah. And apples around 15 carbs, like rice is this much whatever. And so now that I am an adult and I'm doing all my own, like those are still deeply ingrained in me, but I'm not needing to Google and do all of the like heavy work.
Raquel: digging for it as much because of all those years. So I think it's also cool for parents, like if you can use a scale, whatever works for you, maybe even teach your kids how to use the scale, depending on their relationship with food, right? You got to be careful there too. But making sure that you're kind of like saying those numbers out loud and like allowing them to hear it because it's going to allow them to be more intuitive later on.
amandacberg: Yes. And that's what we do at home. Not all the time because she's so little and it can be overwhelming and whatever, but sometimes I'll randomly ask her like, how many grams of carbs do you think is in that? And she'll just guess. And sometimes she's really spot on. And other times she's like a hundred, you know, just being like a silly four year old.
Raquel: yeah it's seems silly
amandacberg: And that gives us an opportunity to laugh and to joke and to be playful with like this topic about food and diabetes. So it becomes light. And it allows for teaching like, Oh my gosh, that'd be so silly. That'd be so much insulin. This is actually 15 grams of carbs. So we don't need that much insulin, you know, and we just move on from it.
Raquel: Yeah. Yep.
amandacberg: Like we don't hyper focus on it or anything. Um, so yeah, that's, that's interesting.
Raquel: yep
amandacberg: That was really, that was really helpful though. That was a good explanation of how you manage those foods.
Raquel: Thank you. Well, what about you? Any interesting times lately that you've like tackled a new challenge?
amandacberg: Yeah, yeah. So um we are, like most of you experiencing some Dexcom challenges. We're still on G6 because she's on Omnipod 5 and we love the auto mode and they're the only ones that talk to each other right now. So we're sticking with G6, but there's definitely just more issues with G6 than there ever have been for us. um in terms of inaccurate readings. And so yesterday, this is a whole other like topic not related to specific management, but yesterday I totally forgot that her Dexcom was due to be changed at 9 .30 in the morning and I dropped her off at school at 8 .45. And so I just walked into the classroom with her with a new Dexcom because I asked her if she wanted to do it at home before and she was like, no, I want to do it at school. I was like, okay.
Raquel: Cool.
amandacberg: walked in and asked um asked her teacher if it was okay to do it in the classroom or if that was a health and safety hazard and she said no you can do it here if Hattie wants and Hattie actually ah like gave a presentation of changing her Dexcom in front of her class.
Raquel: Yeah.
Raquel: That's so cool.
amandacberg: It was super cool she like let her friends pick her new Dexcom spot
amandacberg: it was incredible it was really really cool so that was good and exciting and empowering for her but but obviously then we have 24 hours with a brand new Dexcom and it's kind of off and whatever and so ah I had um
Raquel: Wow.
amandacberg: calibrated it last night because it was reading low, like in the 50s, low 50s. And now we have been asking her, like, do you feel low? And then let's do a finger prick. And so she's starting to get good at when she really doesn't feel low, but we're coming at her with low snacks and she doesn't want them. She will be like, I'm not low. Do a finger prick. I swear I'm not low.
Raquel: Yeah.
amandacberg: So we did that and she wasn't, she was 75 and she's really comfortable at 75. And so, yeah, I calibrated, but then this morning, same thing, it started reading in the 50s and just like was sticking there.
Raquel: Hmm.
amandacberg: I did a finger prick. She was 68, so it was a little bit closer, but not 52 or whatever, you know.
Raquel: Yeah.
amandacberg: And so I um just gave her a bowl of blueberries to munch on, but I did not calibrate this time because it's just, it was too close, you know?
Raquel: Hmm. Yeah.
amandacberg: um And I was thinking to myself the whole time, I need to remember all of these moments so that when we do see her endo and she says, why is her low percentage higher than it typically is with you guys? I can be like, it's not accurate.
Raquel: Yeah.
amandacberg: I swear it's not accurate because this has been happening to us a lot where it's reading low for a long time, you know, and they don't want you to calibrate that much.
Raquel: Yep.
Raquel: Yeah.
amandacberg: And it's like, okay, well, if you only want me to calibrate once a day or whatever, then that's going to be two hours of her reflecting that she's in the fifties when she's actually 91.
Raquel: Mm hmm.
amandacberg: Like,
Raquel: So annoying.
amandacberg: that It's so annoying, so whatever. Take all that with a grain of salt. So this morning I gave her a big bowl of blueberries, and blueberries are sneaky high in carbs.
Raquel: Mm -hmm.
amandacberg: um Yeah, they're they're like the, they they're low glycemic, but they have more sugars and less fiber than any other berry.
Raquel: But they're low glycemic.
amandacberg: And so, um I don't know, I probably gave her a cup, a cup and a half. And I just put the bowl in between her and her sister and was like, snack as you wish. She wasn't hungry yet. We were waiting for that number to come up. So I didn't dose her at all because she was 68 when I handed her that based on finger pricks. And then she started eating breakfast and she had toast, um which again, I was guessing, but I've given her the same amount of toast every single morning for like a year and a half now. So that toast is usually about 25 grams and there were some extra berries on her plate.
amandacberg: And then two egg whites. She doesn't like the egg oaks.
Raquel: Okay.
amandacberg: So there's some proteins to sustain everything. And so I just was waiting and watching and eventually her sugar came out of the red and then was at like 74, and then the next reading was 88. And so now I'm seeing a jump. I'm watching her eat. She's probably at this point, including the blueberry snack I gave her consumed close to 30 grams of carbs.
Raquel: -hmm.
amandacberg: But I'm choosing not to dose for 30 grams of carbs. because the last few mornings, she has gone low two -ish hours after breakfast. But I'm not positive if that is because the carb ratio is too strong or if it's because I've been overdosing, like over um -assuming carbs and of what she's eating.
Raquel: Yeah.
amandacberg: you know So i'm I'm hesitant to change the carb ratio yet because it's human error. And so and instead of changing the carb ratio, I just dose for 20 to start even though I'm pretty sure she's consumed 30.
Raquel: Yep.
amandacberg: And then I wait to see what the next couple readings are. And the next one was like 107. And the one after that was like one twenty So now we're seeing like continuous significant jumps. For us, anything that's over eight to 10 blood sugar points every five minutes is like, okay, let's get more insulin in her system.
Raquel: Right. Yeah. Mm -hmm.
amandacberg: I know that she has a bit of room, a bit of wiggle room before we go high. But I want to get a a bigger dose of insulin in her now so that more can start working faster, if that makes sense.
Raquel: Yep. Yep.
amandacberg: Because if I stay conservative, then there's not as much insulin working at the 15 minute mark when it starts working after delivery, right? And so I dosed for 20 to start, like I said, and then I dosed another 20, so 40 total, because I'm watching her eat still, and she's still now slowly finishing everything.
Raquel: All right.
amandacberg: And she ends up finishing everything on her plate, which is 25 grams -ish worth of um toast and ah probably 10 grams worth of extra berries plus who knows how many grams of blueberries from the snack earlier plus there's the protein from the egg. And so I'm now thinking like the protein from the egg is definitely going to sustain sugars in an hour to two hours time. So I have to be timing what how much insulin
amandacberg: is in her system to start working, to peak working, and then to like still be in her system in two to three hours to cover any delayed highs from a protein spike.
Raquel: Mm hmm.
amandacberg: that Does that all make sense? I'm just kind of like talking.
Raquel: Yes, I think it worked.
amandacberg: Okay. Hopefully it makes sense to the listeners. Anyway, so then I just left it at that. I was like, OK, I'm just going to leave it at this. We'll see what happens if she continues to really skyrocket and there's no slowing of the blood sugar. Then I'll maybe give her more in like 20 minutes. But we get in the car, we go to preschool. I check her right at drop off at preschool and she was at 191 up three.
Raquel: Mm -hmm.
amandacberg: So up three, I'm not going to give her any extra. She has plenty of insulin on board.
Raquel: Yeah.
amandacberg: That was a slight mistime on my end, but it's not the end of the world.
Raquel: Mm
amandacberg: She's barely above 180.
Raquel: -hmm.
amandacberg: But I know there's lots of insulin in her system for the next two to three hours.
Raquel: Yep.
amandacberg: I also know that if she has too much insulin in her system, I drop her off at school, today was closer to nine, and um by 9 .45, they're eating snack. So I have that kind of in my back pocket of like, well, she starts to drop or come down like the snack is happening likely when a low would happen.
Raquel: Yeah.
Raquel: Yep.
amandacberg: And then her next reading is a big drop.
Raquel: Mm.
amandacberg: 168. But I don't call. I don't ask for anything. I'm just going to watch it.
Raquel: Yeah.
amandacberg: And then it's another big drop.
Raquel: Mm.
amandacberg: And then another one. But that third big drop was closer to like a drop of 10, not a drop of 20.
Raquel: Hmm. Yeah.
amandacberg: So now I'm seeing it slow down.
Raquel: Slow down, right?
amandacberg: So even though she's in the 120 -ish, 130 -ish range, and she just had big drops, I'm seeing it slow.
Raquel: Yep.
amandacberg: And I watch it and watch it. Her next drop is to 90, down 10.
Raquel: Mm -hmm.
amandacberg: And now I'm telling myself, be hypervigilant, wait one more. Let's just see.
amandacberg: And if it's another down 10 ish, I'm going to text and ask them to to give her a low snack.
Raquel: Yep.
amandacberg: But the next drop was down three.
Raquel: Yep.
amandacberg: And now she is at 94 right arrow has been in the 88 to 95 range right arrow for an hour.
Raquel: Perfect. Exactly where you want it.
amandacberg: you know, exactly where you want her. So I think a lot of it is like trusting, knowing your pump and knowing its abilities.
Raquel: Yep.
amandacberg: We know the Omni Pod 5 is really conservative and it halts the basal insulin when it recognizes dropping.
Raquel: Yep.
amandacberg: I knew she wasn't going outside to play. They don't go outside until 11. They were sitting inside. And so I just, I just waited, you know,
Raquel: Mm hmm. Yeah, the patience is a huge piece that I feel like I'm always relearning. Like sometimes I'm really good at it. And then other times I will make decisions too quickly, whether that's, you know, if I'm only up three at 190, I might give more insulin. I didn't need to.
amandacberg: Yeah.
Raquel: um but lately I've been dropping a bit before bed but not going all the way low and I've really been making myself like just wait another two or three readings and I never end up going low like I end up sitting at 85 or 90 and as long as I don't have insulin on board I'm perfectly happy going to bed at that point but when I do snack before bed prematurely it's
amandacberg: and
amandacberg: Yeah.
Raquel: I mean, it just, it bumps me up for the entire night. I mean, control IQ brings you back down, but I still, even if it keeps me around 130 or 40, I'd rather be closer to 100, especially for overnight. We've talked about this, like you almost get more A1C points in a sense. um That's probably a confusing way to say it, but like, if your overnights are golden, it's going to improve your A1C so much.
amandacberg: one Yeah.
Raquel: And there's so many less variables overnight. So if you get that locked in, It's just gonna increase everything your time and range and you're gonna feel better and all the things and you to sleep better
amandacberg: And yeah, and not only like in range, but I think that this one's hard to like talk about. If everyone is really comfortable and happy with, you know, like your child is, let's say sleeping at 150, 160, that is in range. That is totally fine. But then if you're seeing your A1C stuck in the sevens or eights, and you're frustrated by that.
amandacberg: you can safely bump down an overnight blood sugar of 150 down to 90 or 100.
amandacberg: If you're on a pump, it's a lot easier to manage, but you give a tiny correction dose to bring that 150 blood sugar down to the 100 mark, and then the pump should in theory take care of the rest with its basal rate.
Raquel: Mm hmm. Yeah.
amandacberg: and so so
Raquel: Or adjust that nighttime basically. Yeah.
amandacberg: Yeah. Um, and that, that causes like significant changes in the A1C and, um, it's not something that you like have to do.
Raquel: Yes.
amandacberg: It's just a trick and something, something to think about if that sounds like you and your family.
Raquel: Yes. And we've said this in past episodes, but in case you haven't heard, like there's this idea of just, if you are higher, um sorry, if you're higher overall, you need more insulin. If you're lower overall, you need less.
amandacberg: Mm hmm.
Raquel: And I was with my, one of my best friends this weekend, Ashley, and she has type one as well. Um, and ah we were kind of joking. She's on the T slim. Um, oh, I forgot to say also, I am in a contracted agreement with tandem. Have to mention that. um But that's unrelated to this so she's on the tandem and just isn't I mean she's on top of her blood sugars But like not as involved in the diabetes space I guess as I am and she would be totally comfortable saying this we're gonna have her on the podcast soon but
amandacberg: Yeah.
Raquel: she just like kept riding high high high and by high like not super high you know just higher than she wanted to be when we were like getting dinner getting ice cream whatever and i wasn't and we were eating a lot of the same things and she was like why is this happening and i was like i feel like you just need to adjust your basils overall and i wasn't telling her what to do i was just like that's what i would do And her basil at the time was 0 .7. And on the first day we were together, she changed it to 0 .9. I was like, even just 0 .2. And the next three days, she was so much lower.
amandacberg: Yep.
Raquel: like It made such a difference. And she was like, what did you just do?
amandacberg: yeah
Raquel: like My endo has seen these numbers, and they haven't changed anything.
amandacberg: Yep. Yep.
Raquel: like How is that little of a change making such a difference? And it's like, you just got to bring that entire line down a bit. And sometimes it's not that hard, but we over -complicate things in our mind. So it's amazing and equally frustrating. you know
amandacberg: Yes, it's it's not that hard if you make your changes when you have very steady blood sugars.
Raquel: Right.
amandacberg: But when you're constantly up, down, up, down, up, down, then it's impossible, not impossible, it's very challenging to figure out exactly what needs changing.
Raquel: Yeah.
Raquel: yeah
amandacberg: Because because then you really are dealing with all 42 variables potentially, you know?
Raquel: literally, and I've been there with all the travel I've been doing. I've been seeing some ups and downs, and I get them down fast because I'm so aggressive with it, and as soon as I start to go up, I'm like, give more insulin. So it's not like I'm spiking high, but when you look at my graph, it does sometimes look like a little roller coaster, and I know that I want to change it, but I have to remind myself also that.
amandacberg: Yeah.
Raquel: There's variability happening. I think that's true for a lot of families right now in the summer when your kids aren't in normal school and they're doing different things. It's hard to adjust when there's so much change.
amandacberg: Yes, it really is. um Is there anything else like I love that you, I mean you kind of just went by explaining Ashley's, um you know, basil adjustment but is there anything else specific.
Raquel: Yeah.
Raquel: um well one random thing because i was just at a bachelorette party this weekend where we went to three wineries in one day and i'm not a big drinker but i don't drink wine that often especially um but like the day after my blood sugars were so low not in a bad way like they were beautiful they were like sitting at 9100 or whatever and i was talking to ashley about it because i was with her after and she was like yeah like it i mean drinking It's known that a lot of drinks will make you drop later. So it was kind of nice in a way, but um it's like weird to actually see that happen and just something that everyone should definitely be aware of, especially if you're drinking a lot more because I did not have much and I still saw a big effect.
Raquel: um
amandacberg: Did that make you change how you dose for foods the next day?
Raquel: Great question.
Raquel: No, I think it just made it easier because I wasn't seeing as much of like a spike from something that I normally it's like I was more insulin sensitive, which just makes it easier to manage overall. And I wasn't really seeing that many lows. But we weren't super active at like during the whole bachelorette weekend, we were in Fredericksburg, Texas, which is like a little wine town and we were walking a lot and it was so hot. But then when I was in Austin for a couple of days after that, um it was raining and we were just kind of sitting inside and working. So there wasn't that activity happening. So for that reason, I didn't.
Raquel: But if we had been walking and been working out and all the things, I probably would have. So again, really depends on those um variables that are happening.
amandacberg: Yeah.
Raquel: But yeah, I don't know. What about you?
amandacberg: Um, yeah, last night we, I had, um, okay, first of all, I just like need to say for all my fellow parents, I am in a state right now with the kids where they are constantly asking for things. Like the chatter is never fucking ending. and it's great and I love them and it's so fun and whatever but like that is so much sensory input all day every day and on top of that they're asking me for things so it's like they're asking questions about how the world works and then it's a relentless can I have can we do why not I want to do I want I want so much can we can I can I want and it's like
amandacberg: exhausting. And so I'm just setting that up as like a preface for my brain come three, four, five in the evening, early ah or late afternoon, evening time, I am like, totally fried.
Raquel: you.
amandacberg: I am not exactly making ah like diabetes diabetes management is on autopilot, basically. And so I could, like last night I made them frozen pizza and steamed broccoli and called it a day. Cause that's all I had and and a smoothie with like fats and protein powder in it, but that's all I could muster. And of course, like when I have a lot of energy and I'm feeling my best and I don't feel like foggy, I can look at the back of the pizza box, but I didn't even do that.
Raquel: Yeah.
amandacberg: And then it was like, I'm not taking the back of the pizza box out of the trash can to check. I don't care.
Raquel: Yeah.
amandacberg: And so, and I didn't pre bolus because I had like remembered to give her a little bit of insulin because she was having a typical nighttime or ah early evening spike, which happens to her a lot in the summertime.
Raquel: Yeah.
amandacberg: I don't know if it's like, I don't know what it is but that happens to her and I know that about her so she was slowly creeping up from the 110s all the way up to like 160 before I noticed and gave her a little correction and then my brain just like kind of let go of diabetes from there so I didn't think about pre -vulsing her for dinner so I just say dinner's ready and then I'm like shit where's your pump phone?
Raquel: yeah
amandacberg: I go and grab it and start. I do the split bolus because it was pizza and I wasn't sure how much of the smoothie she was going to drink and. um Yeah, I started at the split bolus, but because we went into that meal on the higher side. she ended up having a spike from like the 160s to 190 so then I give another like I am sort of slamming insulin at this point so I'm giving another like bigger bolus of like 30 grams so I started with 20 grams then I gave 30 grams worth of insulin
Raquel: Mm hmm.
Raquel: No.
amandacberg: And I think that would have been fine because she ended up eating three small pieces of pizza and drinking her entire, um what's it called, smoothie that had like a banana and a half in it and milk and whatever. But the timing was such that as she was finishing dinner, my husband came home and I was like, I'm out. I can't do this. I'm so tired. And I just like, excuse myself and started to work. And they played Spider, like I said earlier. So it's this big thing where it's so fun. It's like the best thing ever. He's the most amazing father.
Raquel: So
amandacberg: and he like turns into a spider and they chase each other around the house.
Raquel: cute.
amandacberg: But she literally sprints up and down the hallway. She goes in circles like 50 times around the um around the table. And I don't know, I just, i my husband's got it. Like when I tap out, he fully takes over diabetes. It's not my responsibility anymore. and which I'm so grateful for. Thank you, Dani. And I noticed that she was low, but she never got lower than like 68 or something.
Raquel: yeah
amandacberg: So I walked in and ah when he was starting bath for them and I was like, sorry, I overdosed. I was being too aggressive. And he was like, I actually don't think you overdosed. We were playing hard.
Raquel: Yeah.
amandacberg: But I didn't know they were doing that because I had my headphones on. I was super in the zone. He was like, we were playing hard for 40 minutes.
Raquel: Yeah, that'll do it.
amandacberg: And so like that 40 minutes of sprinting coupled with like a fresh big bolus of insulin is what made her halt from going like jumping up 30 points to like immediately stopping and then crashing. And that's just one of those things where if I had my wits about me and I was not so tired, not so worn down, I probably would have thought to myself, he's almost home. They're probably going to play.
Raquel: Yep.
amandacberg: But I wasn't even thinking that I was literally just surviving like, Oh my gosh, just jump 30.
Raquel: Mm
amandacberg: Here's more insulin. Like I'm out.
Raquel: hmm.
amandacberg: And then, you know, in the future, something I want to get better at that I've thought to myself about before, but is to tell him if I'm leaving and letting him take over.
Raquel: Yeah.
amandacberg: If I've dosed her within the last 20 minutes to tell him I dosed her two units within the last 20 minutes. So can you guys play cards or do a puzzle instead?
Raquel: Yeah.
amandacberg: Or if you're gonna play, cause like, I don't want us, we don't want diabetes to stop.
Raquel: Yes, stop that.
amandacberg: the dad playing spider with his four -year -old, like that's those that's all she's going to remember is like screeching from joy.
Raquel: No. Yeah, yeah.
amandacberg: So like keep doing that, but like have two packs of gummies in your pocket, please, kind of thing.
Raquel: Yes, yes. Yeah, I know that's so good.
amandacberg: So.
Raquel: Like, the handing it off part adds such a complexity to it.
amandacberg: Mm -hmm.
Raquel: It's wild and
amandacberg: Mm -hmm.
Raquel: It's, that's like a spontaneous or a spontaneity thing that really sucks about diabetes is just, I actually found myself consciously thinking more about how annoying diabetes was this weekend, which doesn't happen often anymore, but there was a hot tub at the place we were at and in Fredericksburg and um we went in both nights and we were just like sitting in the hot tub.
amandacberg: Hmm.
Raquel: These girls wanted to be in there for like over an hour, just with their drinks, whatever. And that's really interesting to navigate. Um, and it was after dinner and I wasn't going to not do it, but I really had to think about like, like they were like, Oh, we're jumping in right now. Come on, Raquel. And I was like, okay, well, I need to give myself a dose because I'm about to disconnect. I didn't say all this out loud, right? But I'm like doing that and then like bringing my pump out and keeping it nearby. But my Dexcom was on my stomach at the time. So I knew I wasn't going to get readings. I should have had it on my arm. Um, And it ended up being totally fine. The first night I was in there for a bit, but I did get out a little bit earlier than everyone else. And I reconnected, I think I had spiked up to maybe 160, 170, gave a little insulin, just kept my pump in my pocket and like sat with my feet in, but not all the way in.
Raquel: But that's annoying, right? Like, I mean, it was hot anyways outside too.
amandacberg: Yeah.
Raquel: So it wasn't like the most enjoyable anyways. um But it's annoying to have to do that.
amandacberg: Yes.
Raquel: And the next night I actually ended up dropping from being there and I could feel that I was getting low while I was in there. So I got out and that's happened to me in the past with hot tubs. um It might not be because of the hot tub, who knows, but I was getting a little low. So it's just those trade -offs and like having to make those decisions in the moment and not that it's ever a no in my mind but it's like I just want to chill and relax all them and drink in the hot tub but like it's not that simple and I know with Omnipod too you've mentioned not even like then the insulin's in the hot water so that can be a huge problem too like thankfully I could disconnect but I wouldn't want to say no if I'm on Omnipod either so I don't know it just sucks
amandacberg: Yes.
amandacberg: I know that Meg says that she just goes into the hot tub and she personally has never had an issue, but I highly doubt that she's like going in and staying in for 60 full minutes and like not ever giving herself a break.
Raquel: Amazing. Yeah. Yeah.
amandacberg: um
Raquel: yeah
amandacberg: we We don't say no to Hattie just because it's like she's four she can't be in a hot tub for too long anyway.
Raquel: Yeah. Yeah. Yep.
amandacberg: um But in the future I think I'll be I'll I'll just like teach her that if you know you're going into a hot tub and the timing works out with your pump change maybe put it on your arm just so you can like have your arms out of the hot tub.
Raquel: Yes.
Raquel: Yep.
amandacberg: um
Raquel: Yeah, definitely.
amandacberg: But yeah, that spontaneity piece is so hard.
Raquel: There really is, but it gets better and better over time because we learn to work more with it instead of it being like the thing in the way from what we want to do.
amandacberg: I'm sorry.
amandacberg: Yeah, yeah, definitely. I can like feel that, sense that from her already that she's...
Raquel: Yeah.
amandacberg: I don't know that it's just like becoming more and more part of her the older she gets.
Raquel: Yes.
amandacberg: You know, like it's an identifier for her.
Raquel: Yep, I agree with that for sure, for myself at least.
amandacberg: um
Raquel: um I've found myself lately too, not dosing the full amount that I need. I've talked about that in the past, but then I got better about it. Like my pump will say, you know, for 30 carbs you need however many units. And then I'm like, I probably only need four and then I'll watch it. But then I end up spiking and like doing more, but it's not because I'm scared of being low. I'm annoyed from all the lows. Like I don't, I just don't want to be low.
amandacberg: Yeah.
Raquel: It's not fun.
amandacberg: yeah
Raquel: I don't want to drink the thing. Like I don't want to deal with it. but I don't like being high either and then I always regret not like every time like you know this is not what you should be doing like you learn this lesson a thousand times but I still keep slightly under dosing and then causing more work for myself and I think it is just a little bit I don't know definitely not full on burnout like I'm not that annoyed but it's like I've maybe had more lows lately even just with new ah moving to this new town and like walking more and I don't know it's just like annoying
amandacberg: Yeah.
amandacberg: Yeah, yeah, it's yeah, I don't know. I don't know.
Raquel: hu Right.
amandacberg: I don't know how you do it 24 seven other than the only thing that might make it slightly easier in my brain as I'm processing it because I can walk away from it. Like I get my breaks, Danny takes over, my mom helps out, my best friend Karina knows how to do stuff like teachers, you know, whatever. But the one biggest variable for us is never knowing how much she's actually going to eat, what order she's going to eat food in, which significantly impacts blood sugars or like what she's even going to want, you know?
Raquel: Yeah.
amandacberg: And so I think that that is the
Raquel: yeah
amandacberg: the part that produces the most burnout for parents and caregivers, like if we're on the topic of burnout specifically. um
Raquel: Yeah. And like, even when I watched kids, even with Hattie, when I stayed over that one night and she was like dropping into the seventies overnight and the sixties, but then she would go back up to 70 and drop down, which now I know is a normal thing for her. But like, that was so scary for me because it's like, well, whatever if her Dexcom is 30 points off.
amandacberg: Yeah.
Raquel: And like that whole, like you really don't know and you can't feel it. Obviously it's not fun to feel it, but it makes some things easier while other things are harder.
amandacberg: Yeah.
amandacberg: Yeah.
Raquel: Um, that I just, especially with the Dexcom inaccuracy, I think it would give me anxiety. It gives me anxiety as someone who has it and I can feel it, but you don't always feel it the same. Like you even mentioned Patty recently having a low, really low, low that she didn't really notice.
amandacberg: Right.
Raquel: And then other times you do, it's because every time is different.
amandacberg: Yeah.
Raquel: So.
amandacberg: Yeah. That low. God, that was crazy. sometimes I feel like she really can feel when she's high for a long time or low she definitely knows the feeling of ketones which is super interesting and all this is really great but yesterday when I changed her Dexcom in front of the classroom at nine in the morning and I left at like 905 And her teacher decided to do a finger poke to see where she was at around 930, I think in preparation for the snack that was coming at like 940 or something. And she was 48.
Raquel: Yeah.
amandacberg: And I'm so grateful to this teacher for just taking care of it. She like immediately got her low snacks and stuff and she didn't even like text me to let me know what was going on until she like had rechecked her 10 minutes later or whatever, which I personally was like, thank you.
Raquel: Yeah.
amandacberg: It is, i I would have been freaking out and I would have added more work to her plate, basically like update me every single minute.
Raquel: you aret freaking out Yeah.
Raquel: Yeah.
amandacberg: you know because that was a significant drop because when I walked out of the classroom at 905, I had just done a finger poke and she was 110. So like why did she get down to 48 in 20 minutes time?
Raquel: yeah
amandacberg: um But like regardless of all that, I picked Hattie up later. Everything was fine. The rest of the day was fine.
Raquel: Yeah.
amandacberg: Dexcom came back in range and everything was fine. But when I picked her up, I said, Hey, you had a pretty bad low this morning. Miss Kylie pricked her finger and you know, you were, you were in the forties. She goes, yeah. And I was like, did you feel it? She goes, no. And I go, really? Cause you've been feeling your lows lately. Um, I was like, did you maybe feel a little low, but you just didn't want to stop playing. And she was like, yeah, that one.
Raquel: Really? Yeah.
amandacberg: And I was like, okay. Well, I'm so glad that you felt you're low. And I know it's not fun to stop playing, but you do have to tell somebody if you feel low, it's super important.
Raquel: Yeah. Hmm.
amandacberg: So you don't fall asleep and we have to take you to the hospital. And she was like, okay. You know, she was just so annoyed though.
Raquel: Yeah. Yep. That's so annoying.
amandacberg: She's like, no, I'll stay low. We were talking to somebody else recently. Was it Andrea at friends for life or someone who said that they all like stay, they would stay low in class instead of like bring attention to them and ask to go to the nurse or something.
Raquel: Yeah.
Raquel: Yes. Yup. Yup. I mean, I've definitely done that before. And even when I was staying with Ashley, she had a low in the middle of the night. I didn't hear her Dexcom funny enough, but, um, I think it was a fake low, but she told me the next morning, she's like, yeah, I said I was 50 something, but I just knew I wasn't. So I just kept sleeping. And I've done that so many times where you're like, no, it's just not right. Dexcom is having an impression low or something.
amandacberg: Yeah.
Raquel: Um, or you actually are a little bit low, but you're like, it'll go up. It'll go up. And a lot of times it does.
amandacberg: Yeah.
Raquel: You just don't want to get up.
amandacberg: Yeah. Yeah. You don't want to get up. How, how's, how can you like, cause I'm thinking to myself, how do I help Patty? So we're already in play therapy where, you know, we're building with, we're figuring out building blocks to help her.
Raquel: Yeah.
Raquel: yeah
amandacberg: deal with these challenges and hardships and her therapist is saying like we're just putting we're rewiring the brain and we're building really strong neuronal pathways I guess so that she like understands when I'm presented with this problem there is a solution that's easy to get to
Raquel: Yeah.
amandacberg: um instead of like, you know, really trying to figure it out for herself. And so shout out to Play Therapy. um But as you're explaining that, I'm thinking to myself, okay, what can I do? I want to make sure she has a bed. This sounds so silly, but her bed and her nightstand are close together and the height is perfect so that she can literally roll over and reach 90 degrees across to pick something up because I feel like if there's any sort of added work, you have to like reach far, you have to reach down, you have to reach up.
Raquel: Yeah.
Raquel: Yeah.
amandacberg: It's going to be one more. It sounds so silly, but that's how I work sometimes where it's like, I have to reach a little up instead of 90 degrees.
Raquel: Yes.
Raquel: Yeah.
amandacberg: I'm dead asleep. I'm not doing it.
Raquel: Yeah.
amandacberg: And so does that all make sense? like
Raquel: It does because I've been doing that for myself lately so I do have one that is, it was accidental but it's like perfectly aligned with me. um And I've started buying these juice, the Mott's Juice bottles from Target specifically for nighttime lows because you can open it, have it by your bedside table, take a few s sips and not drink the whole thing and close it.
amandacberg: Mm.
Raquel: Sometimes you need more, sometimes you need less. I don't know if really it's supposed to be refrigerated but honestly I don't.
amandacberg: Mm.
Raquel: um And it's so easy. There is something awful about eating actual food and chewing in the middle of the night, unless you have one of those lows that like awakens that extreme hunger where you want to eat everything. But those are only really bad lows. The other lows that are just slightly low and they're annoying, you just want to chug something really fast and go to sleep. And I know juice works so fast too.
amandacberg: Mm hmm.
Raquel: And so that's my go -to. um You could probably even say the same about like yogurt pouches. Um, or applesauce maybe, but it doesn't always work that fast for me. So that's been my easy thing. They're like surprisingly hard to find. Like they're only in certain stores, like the actual juice bottles, not juice boxes.
amandacberg: Oh yeah.
Raquel: Because with juice boxes, it just, if I don't need the whole thing, then it's just kind of like awkwardly there and like you can't like actually close it.
amandacberg: Yeah.
Raquel: Um, so that's one thing, but otherwise it is it is what it is. You have to treat it.
amandacberg: Yeah, I know. I know. I'm thinking about the sugar pixel, too, I think is like as she gets older, if she wants more autonomy, like sugar pixel and you can adjust the alarms and stuff.
Raquel: Yeah.
amandacberg: So probably. I don't know. I would let her figure out what alarm she wanted.
Raquel: Yeah, like Tate loves it, but she also, cause she doesn't wake up to lows. She goes through long periods of time or she doesn't want to use it just cause she gets so annoyed with the alarms because it's just, it creates some, I think it can create some burnout too, right?
amandacberg: Oh.
Raquel: When it's like over alarming and she also feels really guilty with
amandacberg: if you're constantly alarming, yep.
Raquel: living with a roommate and having that obnoxious of an alarm, honestly. You can't enter a room or anything. It's like really, really loud. Obviously, the sugar facial is nothing but amazing. It's just the reality of having a really loud alarm screaming at you.
amandacberg: Yeah.
Raquel: So yeah, yeah, that's good though. I mean, allowing her to make those decisions and how she wants to be alerted. I've actually really loved um I love that the T -Slim and the Moby both vibrate when you're low and so it gives me an extra security that I will physically feel it if it's in my waistband or even if it's next to me when I'm low and I also so sleep with my Apple Watch now that it tracks sleep and so that will also buzz and I don't hear my actual Dexcom alarms that much with the way that I have them set up and the buzzing is just so much more nice and gentle.
amandacberg: Hmm.
amandacberg: Yeah. Yeah. We never have Hattie's alarms on, on her Dexcom phone. We only have them on our follow app just because I think the alarms are pretty triggering for her and she would never say anything. But one of my biggest fears is that she suppresses how she's feeling and she feels like she can't verbalize like I'm really frustrated. You're doing this. You're doing that. Like I I yeah. So we just like don't have those alarms on at all for her.
Raquel: Yeah.
amandacberg: But there have been some times where someone else has had the phone. So we do put them on and then I forget. And an alarm goes off in the middle of the night in her room. And it is so dang loud. And she is just like sleeping like a log as if nothing has happened.
Raquel: Yeah, that might change as she grows. I mean, I'm so thankful Alarm's wearing a thing when I was little, honestly. I wish they were for my mom, but like, I'm glad I didn't have to and experience that as a little kid.
amandacberg: Yeah.
Raquel: That's just a lot.
amandacberg: Yeah, they trigger me, honestly. It's like, I i don't have mine on loud.
Raquel: Same.
Raquel: Not so much.
amandacberg: I just, no.
Raquel: Yeah.
amandacberg: Yeah. um All right. I mean, we went through a lot and we're already at the 50 minute mark.
Raquel: Yes, let's do a little roll call.
amandacberg: Okay.
Raquel: I'm 160, but my DAX column is really off. I'm about to take it off.
amandacberg: Hmm.
Raquel: like I can see almost see through each to the little needle thing. like It's not there.
amandacberg: Yeah. No, got to get that off. Hattie's 114. Nice and steady.
Raquel: Very nice.
amandacberg: Sweet. All right. We will see everyone next time.
Raquel: Bye. ay
amandacberg: Bye.
