{"id":34869,"date":"2013-12-19T11:33:04","date_gmt":"2013-12-19T16:33:04","guid":{"rendered":"http:\/\/asweetlife.org\/?p=34869"},"modified":"2015-12-27T15:45:32","modified_gmt":"2015-12-27T20:45:32","slug":"pasta-gelato-and-the-end-of-the-diabetes-honeymoon","status":"publish","type":"post","link":"https:\/\/asweetlife.org\/?p=34869","title":{"rendered":"Pasta, Gelato, and the End of the Diabetes Honeymoon"},"content":{"rendered":"

About 10 days after Bisi started on the pump, the four of us joined my mom for a week in Tuscany. We had a great time; how could you not? But in terms of Bisi\u2019s diabetes, the trip was difficult. Part of the problem was that all of us were still very new to the pump, so we didn\u2019t totally trust it. Another part was that we were eating out a lot, and the food Bisi most wanted\u2014buttery, cheesy pasta and then gelato for dessert\u2014is disastrous for her blood sugar, and also very different from how we normally eat at home (lots of protein and vegetables, with few starches). But part of the experience in Italy is eating lots of great pasta. And it wouldn\u2019t have been fair (or feasible) for some of us to eat pasta while making Bisi skip it. The third part of the problem didn\u2019t become clear until about halfway through the trip, after several calls to Bisi\u2019s diabetes nurse educator about her crazy-high blood sugar numbers.\u00a0<\/p>\n

\"\"<\/a>
Bisi and her brother, Jamie, near the top of a bell tower in Florence, looking out over the Duomo<\/figcaption><\/figure>\n

When we started the trip, Bisi was typically taking a total of about 2 units of insulin a day. On days when she ate lots of carbs\u2014say, where she\u2019d go to a birthday party and eat cake and pizza, the number was more like 4 or 5 units.<\/p>\n

But what we found on the trip was that this amount of insulin was completely inadequate. We\u2019d be correcting her at 10 pm, then again at 2 am, then again at 5 am, and then sometimes she\u2019d still wake up high. With the jet lag and the multiple wake ups a night, we were exhausted. We changed her carb ratios downward each day, but throughout the trip we always felt like we were a step\u2014or twenty\u2014behind the diabetes. Was it the time change or the stress of travel? Bisi\u2019s nurse educator said that both of these factors can have an effect on blood sugar. Was the pump not working? It was hard to keep on trusting this little pod on her body when her numbers seemed so out of whack. At times when she was over 250\u2014and there were a lot of them\u2014we would test her ketones to make sure acids weren\u2019t building up in her blood due to lack of insulin. (A worry with the pump is that it will stop working but you won\u2019t know it. If the pump conks out and is not giving the tiny drip of basal, or baseline, insulin that Bisi needs throughout the day, a dangerous level of acids could build up in her blood.) But her ketone levels were never over .02 (.05 is when we\u2019ve been told to worry).\u00a0 She was getting insulin, just not enough to cover the carbs she was eating.\u00a0<\/p>\n

It was on this trip, though, that we experienced our first pod failure\u2014something that I\u2019d heard could be a problem with Omnipods. We were in Siena, and Bisi was about to have a plate of pasta for lunch. We gave her a bolus of over two units to cover about 70 carbs. Right at the end of the bolus, when she\u2019d gotten all but the last .05 unit, the pod on Bisi\u2019s leg started screeching: BEEEEP! We couldn\u2019t get the pod to stop screeching\u2014normally, you just press a couple of buttons on the pod\u2019s controller, and the beeping stops. But this one would not shut up. Bisi and I went into the bathroom and I peeled it off her leg. I didn\u2019t want to leave a noisy thing beeping in the bathroom (it sounds kind of like a loud timer, with a sustained high-pitched beep). So I wandered out onto a busy Siena sidestreet and surreptitiously dropped it in a trash can. We passed the can a couple more times, since it was by the town\u2019s main square, and I could still hear the pod beeping. \u201cIt\u2019s calling for you,\u201d I told Bisi. \u201cIt misses me!\u201d she said. I had images of being jailed for dropping something suspicious in a trashcan, but luckily the carabinieri were not that efficient.<\/p>\n

It was also on this trip that we learned how accommodating Italians are about a gluten free diet. (We are still keeping Bisi on a modified gluten-free diet. We cook without gluten at home, and keep her meals gluten free when we can when we\u2019re out; but if all of her friends are eating cake and pizza at a party, we no longer make her eat a substitute. Having T1D is hard enough, without always feeling isolated by what you\u2019re eating.) Each grocery store had a large gluten free, or senza glutine, section at the front. And if restaurants didn\u2019t have their own gluten free pasta, they were happily willing to cook what we brought. (Here\u2019s a good post from Gluten-Free-Girl<\/a>\u00a0about Italians\u2019 friendly attitude towards this particular dietary restriction. In general, as she points out, Italians are much more aware of celiac disease than Americans are; and all school children are tested before entering kindergarten.)<\/p>\n

About halfway through the trip, as we struggled to keep up with Bisi\u2019s surging blood sugar by changing her carb ratios and basal dose and by giving her extra tests and insulin corrections after meals, Bisi\u2019s nurse told me that she thought there was something more going on than a change in diet and time zone. \u201cI think her body\u2019s changing. Her insulin needs are growing, and it\u2019s just coincidental with your trip.\u201d Essentially, her diabetes honeymoon, which had been waning for months, was officially over. By the end of the trip, Bisi was taking 11-13 units a day, and we still never felt like we achieved good blood sugar control. Once home, her basal needs came down a little bit, but her carb ratios have never gone back down to their pre-trip levels.<\/p>\n

It\u2019s hard to convey how stressful this feeling of never getting control over her blood sugars was, amidst all the change Bisi was going through\u2014a new method of insulin delivery, a much higher level of carbs, a new place with a different time zone, and a different response than we were used to from her body. We\u2019ve been to the same place in Italy several times with our kids, but this was the first time since Bisi\u2019s diagnosis. In daily life, I\u2019m so used to Bisi\u2019s diabetes that it\u2019s often not a big deal. But the contrast between this trip pre-diabetes and with diabetes was hard\u2014the constant worry over blood sugar numbers we weren\u2019t doing a good job of controlling; the push-pull between enjoying the delicious food there and dreading what those meals would do to Bisi\u2019s blood sugar. I\u2019m not sure what the answer is: Doing a better job anticipating the highs Bisi tends to have when we travel? Or letting go a bit and realizing that traveling is always going to make things more difficult diabetes-wise, but that\u2019s okay. Probably a little bit of both.\u00a0 What I do know is that it\u2019s worth doing the work to figure it out. The worry over Bisi\u2019s health during that trip will stay with me, but so will memories of the kids biking around the walls of Lucca, climbing up towers in Siena and Florence, working on their school journals over leisurely lunches, and picking their favorite Botticelli in the Uffizi. We can\u2019t\u2014and we won\u2019t\u2014let this disease turn us away from the places we love to go and the things we love to do.<\/p>\n

\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"

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