Set change

I stare at the flow chart. Blood sugar is over 300 –> Check for ketones –> No ketones, check again in an hour –> Still over 300, give insulin via a shot, then change the pump set.

Nick’s been over 300 since dinner. We should have rechecked him around 9 or 10 p.m., dealt with this then. But Bobby didn’t know about that check because he’d made a video run and I didn’t know about the later ones because I’d passed on The Godfather (his Father’s Day choice), opting for bed instead. (Yes, it’s a great movie, an American classic, but I’ve seen it and I’m over the genre.) I should’ve said, “We need to recheck Nick at 10 p.m.” But in my exhaustion – and because the pump has, for the most part, smoothed out the highs and the lows, lulling me into security – I didn’t. So they didn’t check until midnight, after the final close of the door. And not knowing about the earlier reading, Bobby simply waited up another two hour to recheck. When the 2 a.m. check showed him still over 300, Bobby woke me up, unsure in his exhaustion what the next step should be. That’s when I went to the chart.

This is the only problem we’ve had with the pump: sometimes the night before a set change, something stops working and Nick’s blood sugar shoots up, stays up. The ordeal always occurs in the late night/early morning hours – seems to be the nature of diabetes to attack when we’re all most vulnerable.

So we had to wake Nick up, get him to pee on a strip that would tell us if ketones had developed in his blood.

(“If you don’t have enough insulin available in your body, and the blood glucose rises, your body will eliminate the glucose by passing it into your urine. As your body takes fluid from everywhere it can to help dilute the urine and pass the sugar out, you’ll get dehydrated. Because the glucose is passing out through the urine, the body is starving and fat will burn. If the body burns too much fat too quickly, ketones will accumulate in your bloodstream. Ketones make your body too acidic, which will upset the body’s chemical balance. Your body might not be able to excrete the ketones adequately. In this setting, if your glucose is high, you are dehydrated, and your ketones are large, then your body’s chemical balance is disrupted and you could develop a life-threatening condition called ketoacidosis.” Source.)

All clear, thankfully. Before I knew anything about Type 1 diabetes, two-and-a-half years ago before our lives were redefined by the disease, when we thought Nick was just run down, just suffering some inconvenient-but-normal malaise that would pass, he developed ketoacidosis. The nurse explained the condition to me on the plane, the Cal-Ore life flight, a tiny bullet of a thing, shooting us to San Francisco and rescue from at least that much.

After arguing with Nick about whether the set change was necessary – 2 a.m. does not seem to be an hour at which we are at our finest – we reached agreement. When I type “reach agreement,” what I mean is, I gave up trying to gently explain to my tired and frustrated young teenager, and raised my voice. “It says to do it!” I said, shaking the paper at him. He’s such a trooper most of the time, nearly all the time. I can think of only one instance of self-pity, of him acknowledging out loud, “Having diabetes sucks.” Whatever’s going on in his mind, on the outside, his focus is on what needs to be done about it here-and-now so that he can get about doing what he wants to do.

Tonight was close, though. The improvement of the pump includes reducing needle interaction from an average of five shots a day to a set change every three.

(Not my hand.)

That’s huge. I love not having to stick needles through my son’s skin several times a day. But the set needle is bigger, longer, scarier. I exhibit calm, but sometimes queasiness hits as I push the sharp end through Nick’s flesh. And anger. I hate that he has this disease. I hate that I’m helpless to fix it, that my “help” involves me causing him pain. He rarely complains about that either, just breathes steadily until the set needle is in and out, infusion tube successfully inserted. Bobby’s better at it than I am, so I leave it to him whenever possible, even though passing it off feels like shirking responsibility. I feel guilty for being glad Bobby’s willing to take it on. He did it tonight, too, the two of them so tired, Nick leaning on the wall as Bobby crouched next to him, finding the best angle.

And then Bobby went to bed and I came to the computer, thinking I could use up an hour typing this all down. I wish surfing was all I had to write about – and I am a few sessions behind – but the north wind’s up and our dream of surfing every day in June blown away. It’s time to check Nick now. Hopefully, he’s fine. Hopefully, I won’t be back at the keyboard in five minutes. Hopefully, we’ll all get some sleep.

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