Oh, School Nurse, How Do I Love Thee!

Mrs. P is the nurse at Ally's school.  (To protect her identity, even though I'd like to scream her name from the mountain tops, I will call her Nurse P.)  I may best describe her as an angel here on earth!

If you read my post Day In The Life from last May, you will know that I worry a lot about Ally being away from home, away from me, for 8+ hours a day.  Even though it was written last year when she was just a first grader, I still have the same feelings throughout the school day.  I notice the clock at each scheduled blood glucose check time.  I hold my breath for a few minutes, wondering if the nurse will call.  Then I have a little sigh of relief and wait until the next BG check time, ultimately looking forward to seeing her get off the bus at 4:05pm. 

The only thing that gets me through these school days is the confidence that I have in our school nurse.  She is AWESOME!

Dear School Nurse, How do I love thee?

Let me count the ways!!!

She thanks me for all that I do for Ally.  Let me say that again....She thanks me for all that I do for Ally.  Her words, "I appreciate the time and dedication you take with Ally."

She advocates for Ally.  Last year when H1N1 was a concern, she moved all of Ally's D supplies out of the clinic and arranged for her to use the principal's office for all D management in order to keep her away from the "sick" kids.

When Ally buys school lunch (which is not often), she walks down to the cafeteria with her and makes sure that Ally gets exactly what I requested and also what she has pre-bolused for.  She worked with the food service staff so that now the monthly school lunch menu includes carb counts for all foods.

She encourages Ally's independence by allowing her to check her own BG, change lancets,  enter info into her pump, and record info on the log slip (the one that comes home to me; nurse records on school log book).  Of course she is looking over her shoulder the whole time!

She tells me when Ally's D supplies are running low.

She is aware that I have been making some adjustments in Ally's basal rate and carb ratios lately.  So she called me today with a full explanation of Ally's BG numbers.  (I usually recieve a slip of paper each day listing all of Ally's BG numbers, carbs, coverage, etc for the day.)  She took the time to discuss with me what "could" be happening.  She really feels part of Ally's diabetes management team.  She said, "This is what I did"..."would you have done anything different?"

She praises Ally for recognizing "low" symptoms.

Some of this may sound easy to you, but let me assure you that Nurse P is one busy lady! Ally attends the public school in our community. This grade 1-5 elementary school has approximately 50 classrooms. With an average of 25 students in each class, that is about 1250 students! It is so large that they have 2 principals, so you either attend the "West" or the "East" side of the school. In many ways they function as two separate schools, even though it really is only one. Nurse P is the sole nurse for all 1250 students.

She acts as the liason between our family and the school, communicating with the teachers often about Ally.  We recently adjusted some of Ally's basal rates and I get a little concerned about lows when we do.  Without my asking, Nurse P said, "I'll let Mrs. M (classroom teacher) know that we are making some changes so that she understands if Ally needs to make extra trips to the clinic for a few days.  WITHOUT MY ASKING!

She knows when Ally's teacher is absent and lets me know (not that I can do anything about it, but if she's taking the time to tell me then I know she is taking the time to touch base with the sub).  Again, let me reiterate that there are 50 classroom teachers in this building!  She makes it her business to notice when Ally's teacher is not there.

She has five type 1 students in this school.  We all don't handle things the same way.  Only two of the girls are pumping.  Ally goes to a different endocrinologist than the others.   Some bolus after meals; We pre-bolus.  Some are allowed "free" snacks if they are 15 carbs or less; We bolus for all carbs!  So Nurse P has a lot of factors to remember for each T1 student.  They are all on different schedules, but if Ally doesn't come to the clinic at one of her BG check times, she calls down to the classroom to remind them.

She gets it.  She understands the seriousness of this disease.  She is diligent.  She is confident.  She is not too proud to ask me if she doesn't know.

Does Nurse P make mistakes?  Sure.  Does she occasionally make a judgement call that may be different than what I would do?  Yes.  But do any of us get D right all of the time?  NO WAY!

And did I mention that she thanks me!!!  I LOVE HER!

I know that others do not have a wonderfully awesome nurse like we do.  Some don't even have school nurses!  (So sorry Meri!)  So, I do not take for granted for one day how lucky we are to have Nurse P.  It makes my days away from Ally that much more bearable.

A few other experiences with school nurses that you may be interested in:
The Sugar Kids
We CARA Lot
My Diabetic Child

Happy Bloggy Birthday to Me!

So I just happened to notice that my first blog post ever Celebrate You was posted one year ago today!  I went  back and re-read it.  I thought that it would be fun to repost it today in honor of my 1st Blogging Birthday :)

First, let me say that a year later, I still Celebrate You!  I have learned so, so much from the DOC (Diabetes Online Community).  I am so thankful for the knowledge, comfort, support and most of all friendship that you all give me every day!  Looking forward to another year with all of you!


Celebrate You...A Note to Fellow D-Blogging Mommas!
originally posted by Misty on March 10, 2010

My name is Misty and I am new to this blogging world! For a year now we have been living the same life as many of you. A life that we did not ask for. A life that we cannot change. A life where our little girl has to pay the price for a senseless disease. Our daughter, Allison, was diagnosed with Type 1 diabetes on February 10, 2009. She was just 5 years old. On that day, our whole world changed!

Ally's Kindergarten picture, taken a couple of months before she was diagnosed with Type 1 Diabetes. 

(P.S.  I use this picture a lot.  I think its because I want to remember her with that oh so carefree smile!)

But today, I want to CELEBRATE You! I want to celebrate that Hallie introduced me to this online community. I want to celebrate that so many of you have reached out to me, welcoming me into this group of people who understand what our life is like. I want to celebrate that some of you forced me, ok...encouraged me to write this blog. I think it will help.

In fact, it already has. You see, I was only introduced to you and your blogs a couple of weeks ago. Once I started, I couldn't stop reading them. As I read some of them, I felt like you were writing the thoughts right out of my head. Others were compelling, some were shocking! I have smiled, laughed and cried at your blogs.

Ally noticed that I couldn't pry myself away from the computer and she asked me what I was reading. I explained that I was reading about other families who have children with Type 1 Diabetes. She was interested. "Mommy, can I read it too?" So I let her write a note to a couple of girls her age. She received a note back from both of them and is ecstatic! (Thank you ladies!) She wants to know all about them. She made me print their notes and she ran to find an old binder that she could keep them in. They were so special to her that she would not let me punch holes in them, so we had to find page protectors! She is scheduled to be Star of the Week in her 1st grade class in a week or so. She has been waiting for her turn for a long time and has about 20 "special" things that she wants to take in to share. This afternoon she told me that her MOST special thing is now her binder with her "new friends" in it and she can't wait to take it in to share with her class. :)

So, again, let me CELEBRATE you! Connecting with others who understand is already making a difference for me...and even better, for Ally!!

Things That Make You Go Hmmmm!

So, I've been wondering....

Do showers or baths have an effect on your (or your child's) blood sugar?

I have noticed that Ally seems to have a spike in blood sugar after taking a hot shower or bath.  It is not an immediate spike, but she will end up high a couple of hours later.  I noticed this almost as soon as she started pumping.  Since she disconnects her pump while she showers, I thought that possibly its because she is missing the basal dose of insulin (the insulin that controls blood glucose levels between meals and overnight).  Then I started limiting her shower time to no more than 10 minutes.  10-15 minutes disconnected from the pump would not normally make her have a blood sugar spike.  Didn't matter.  Hmmm...

I have started noting in her log book when she showers and here is a brief example of what I'm seeing.  For these examples, I looked at 4 days in a row, same time of day.

Day 1    BG before shower  80....3 hours later 207
Day 2    BG  (no shower) 146....3 hours later 160
Day 3    BG before shower 128...3 hours later 242
Day 4    BG  (no shower) 107...3 hours later 98

As you can see, on the days that she did not shower at this time of day, her BG was relatively close 3 hours later.  On the shower days, she spiked significantly.  Hmmm...

 (As I'm typing this, I am thinking that I need to go back and look at her CGM graphs from those days to see when the spike is occuring.  Is it just one hour later or two+ hours after the shower?  That might give me some more insight.)

We all know that blood sugar levels are influenced by so many factors.  I have also considered this.

I mean, in the mornings we are dealing with the dawn phenomenon.  (Our body secretes hormones in the pre-dawn hours which cause our bodies to be more insulin resistant.  Your pancreas would naturally release a little more insulin if it were a properly functioning pancreas.  We have to adjust Ally's basal rate to deliver a little more insulin during these hours.)  It has taken some hard work (and often continues to be a challenge) to manage Ally's morning blood sugars while avoiding a drastic spike in blood sugar after eating breakfast.  Hmmm...

The liver stores sugar in the body.  Stress can cause the liver to release sugar into the bloodstream which would raise blood sugar levels.  Is the hot shower water a "stress" on Ally's body?  Hmmm...  

My COMPLETELY un-medically-educated brain has a theory.  It (my brain) sees this possible scenario:  Ally wakes up in the morning, takes a shower, boluses for breakfast carbs & eats...HUGE SPIKE!  Is the shower causing her body to be resistant to the insulin which she is getting for her breakfast carbs, thus causing her to have these spikes later when the food is breaking down into sugar?

MedicineNet.com defines Insulin resistance (IR) as a condition in which the cells of the body become resistant to the effects of insulin, that is, the normal response to a given amount of insulin is reduced. As a result, higher levels of insulin are needed in order for insulin to have its effects.
I did run this theory by the "professionals" at our endo visit today.  Funny thing...they think my brain is fried!  Just kidding.  They said that they would almost expect the opposite; that a hot shower or bath increases blood flow, getting that insulin really flowing, thus lowering blood sugar.  Hmmm...

What are your experiences with Type 1 Diabetes, insulin and hot showers?  (Let's keep it related to blood sugar numbers, ok!)