Caring for our T1D

Let’s get right to the point: if you’re reading this, you have some pointed questions about how to care for Teddy and, specifically, managing his type-1 diabetes (T1D).

Before we get into that, let me take a minute to ease any concerns you have.

For the most part, Teddy’s condition is very easy to manage. In more than a year we’ve only dealt with one dangerous situation (he had a stomach bug, tossed all his food, and couldn’t consume anything else to raise his blood sugar). Outside of that single incident, his tech has provided immeasurable relief to what is, ultimately, a life-threatening chronic condition.

This post covers the most dire emergency situation at the very end. The rest helps you build a mental framework for the safeguards that exist and how to course-correct as necessary.

More good news: Teddy understands all of this pretty well and can help you make decisions about his care. We’re also happy to answer any questions you have and are only a call or text away!

What is Diabetes?

Simply: a body’s inability to manage glucose (sugar) through its own insulin production.

For type-1 diabetics, like Teddy, the pancreas produces little or no insulin whatsoever. For type-2 diabetics, the body cannot produce enough insulin and cells become less responsive to insulin.

There is no cure for either type. In the case of T1D, the only answer is medically prescribed insulin therapy. We provide insulin to correct high blood glucose (BG) or additional carbohydrates (carbs) to recover from low BG.

How do we measure?

With T1D, we closely measure and monitor a person’s blood glucose (BG) values.

A perfect score is 100. The nominal operating zone is anywhere from 80-120.

Lows:

Anything below 80 is considered low.
Anything below 50 is dangerously low.
Anything below 40 is critically low.

Highs:

Anything above 120 is considered high, but 180+ is where we think about intervening.
Anything above 300 is dangerously high.
Anything above 400 is critically high.

Teddy’s Diabetes Tech

Thanks to the advancement of technology, managing T1D is far easier today than it was even 5 years ago.

Teddy wears a continuous glucose monitor (CGM) and a tubeless insulin pump. These two devices keep track of his blood glucose levels and provide his body with insulin around the clock. It’s almost like having a bionic pancreas.

On his person, Teddy always carries:

an iPhone to monitor the CGM and audibly alert of highs/lows.
a “Personal Diabetes Manager” (PDM) to control his pump.
a few glucose tablets that contain 4g of carbs each.

On longer outings, we also regularly pack a “go bag” that includes:

A “finger stick” blood glucose monitor for immediate reads on his BG
- The CGM value has a margin of error of 10% and lags reality by ~10min. Not a big deal except when he’s low and/or rapidly dropping.
Various recovery carbs (typically gummies, airheads, and tablets).
Emergency rapid-acting glucose if he gets so low he goes unconscious.
Ketone strips to test for excess ketones (when BG has been higher than 300 for longer than one hour and unrelated to eating any food).

Dealing with Lows (BG <80)

Don’t fret, but be swift!

Feed Teddy sugar, stop physical activity. He needs 4-6g of carbs if his BG is at 60-80 and as many as 8-10g if BG is dropping fast and below 60.

Stick to simple sugars — gummy snacks, glucose tablets, skittles, hard candies, and fruit juices are all great candidates. Stay away from things that are high in protein or fat (e.g. chocolate) because they slow the body’s ability to absorb glucose.

Teddy’s CGM phone will alarm if his BG drops below 80. It will sound more and more urgent the lower his BG falls and it cannot be silenced – the volume cannot even be reduced (somewhat annoyingly). Because of this, you should be able to catch them quickly.

Lows are the most dangerous thing about diabetes and should be treated quickly. In extreme cases, if his BG slips much below 40 he could go unconscious and emergency intervention is necessary.

Thankfully, his BG typically bounces back after ~15 minutes and he can resume physical activity once he’s trending upward. We typically wait until he’s above 100 to resume running wild.

Dealing with Highs (BG >200)

If it has been more than 2 hours since he was last given insulin manually (e.g. for a snack or meal time), attempt to administer more insulin via his pump controller:

Tap the “bolus” button at the bottom of the screen.
Enter 0g for carbs
Tap “Use CGM” to populate his current BG value.
If the pump is willing to administer more than 0.1U of insulin, tap “Start” and confirm.

If the controller calculates a dose of zero units, encourage him to drink water and get more physical exercise (walking, running, etc).

Highs are less urgent because they don’t carry the same risk of losing consciousness and are fairly slow to correct even with immediate intervention. In fact, within the context of a single day, highs are much more annoying than they are dangerous.

Long-term – as in multiple days/weeks – untreated highs >300 are responsible for all the scary complications of T1D you may have heard about (organ failure, loss of extremities, blindness, etc).

Eating Snacks & Meals

Teddy can eat any kind of food he likes – nothing is off limits. Naturally, we still recommend a nutritionally balanced diet, but he doesn’t need to be restricted from certain types of food or anything like that.

Any time Teddy eats food containing carbohydrates (carbs) he must receive insulin to cover these carbs, ideally 5-10min before he starts eating.

Add the “Total Carbs” values for each serving of food he’s eating. Then, use his pump controller to administer a dose of insulin (called a “bolus” dose) to cover those carbs:

Tap the “Bolus” button at the bottom of the screen
Enter the total carbs for the meal
Tap “Use CGM” to populate his current BG value.
Tap “Start” and confirm.

The PDM handles all of the math to determine how much insulin to dispense. The pump itself will beep once the dose is finished.

Dealing with an emergency

If Teddy’s BG is so low that he is rendered unconscious, immediately: (1) administer his emergency rapid-acting glucose per its instructions, (2) call 911, (3) call us. In that order.

Steps 2 and 3 can be simultaneous if you have 2 people capable of making phone calls. Teddy’s CGM phone has our numbers stored on device and you can tell Siri to “Call Dad” or “Call Mom.”