Flu Season Tips

updated 2/25/20

Flu season has arrived and the sad fact is that no matter how hard you try, sometimes you just can't avoid getting the flu. Dr. Adam Naddelman, MD, FAAP, President, Princeton Nassau Pediatrics, P.A. has a few tips on how to elude the flu, spot the virus in it's early stages, and what to do when you think that you've been bitten by the bug.

Preventative measures (from flu.gov)

Avoid close contact with people who are sick. When you are sick, keep your distance from others.

Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. This will help prevent spreading your illness to others.

Cover your mouth and nose with a tissue when coughing or sneezing. Flu and other serious respiratory illnesses, like respiratory syncytial virus (RSV), whooping cough, and severe acute respiratory syndrome (SARS), are spread by cough, sneezing, or unclean hands.

Clean your hands. Washing your hands often will help protect you from germs. If soap and water are not available, use an alcohol-based hand rub.

Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

Practice other good health habits.Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

Early flu signs

• Fever, usually 102º - 104º

• Cough

• Body aches that can be severe

Once symptoms begin
People who are high risk (chronic illness like diabetes and asthma, elderly or kids under 2) should seek medical care quickly. If the flu is diagnosed within the first 48 hours, antiviral drugs can be prescribed in hopes of shortening and/or lessening the effects of the flu. A full list of who is considered to be high risk can be found at Flu.gov.

For those considered low risk, Dr. Naddelman believes the best treatment is supportive care, including plenty of fluids, antipyretics to reduce fever and body aches, and lots of rest. 

Considering emergency medical assistance? Listen to episode 307 of the Juicebox Podcast

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Dr. Adam Naddelman, MD, FAAP

Dr. Naddelman stresses the importance of being on the look out for secondary infections with the flu, particularly pneumonia. Signs of influenza leading to a secondary bacterial infection like pneumonia include a high spiking fever several days into the illness, increasing cough and lethargy, and decreased appetite and oral intake. These signs require immediate medical attention.  

Once you've kicked the flu waiting twenty-four hours to reintroduce yourself to the public after your symptoms and fever have resolved is considered best practice.

Dr. Naddelman practices pediatrics, but his advice is transferrable to patients of all ages.

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I've gathered some links from the Children's Hospital of Philadelphia (CHOP) that you may find helpful if your child with type 1 diabetes falls prey to the flu.

Ketone/Sick Day Rules - Insulin Pump - pdf

Ketone/Sick Day Rules - NPH - pdf

Sick Day Log Sheet - pdf 

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This is a very good time for me to remind you that I am not a doctor and that nothing I write on Arden's Day or anywhere else should be taken as medical advice. My disclaimer says it all but you should really contact your own physician whenever you have questions about your or a loved ones health. Especially when the flu is involved. 

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Corona Shelter In Place: Update One

Before I began podcasting I did a fair amount of blogging, please bear with me while I remember how to write.

It’s March 19, 2020 and my family has been voluntarily sheltering in place for six days. Overall the time has been pleasant but I want to share a few things that I’ve noticed as the days pass.

Arden seems to like distance learning better than going to school, this was not surprising as she has been able to adjust her busy hours to meet her natural sleep pattern.

Kelly is working more hours which is allowing her to conquer tasks that would normally take more time. Saving commuting time is helping tremendously. I do worry that she isn’t taking enough breaks.

Cole has been sent home from college and the NCAA has cancelled the spring sports season. He is figuring out how to channel the massive amount of energy that he usually directs into playing baseball. Yesterday he got outside for the first time and the activity was good for him.

The house has never looked better, cleaning has become a pastime for a few of us. Arden spent a day cleaning the kid’s bathroom and it is sparkling.

Everything still feels pretty normal with the exception of how often we visit stores but the specter of what may still be coming is difficult to ignore. I find myself worrying most about food, security and diabetes supplies.

I’m going to spend this time working on the Juicebox Podcast by recording, editing and prepping future episodes. I’d like to add some home exercise to my day - I need to do that.

I’m hoping that you will use your time for something that you haven’t previously had the bandwidth for. Refocus on diabetes management, try that planking challenge - whatever. Just as long as you can look back on these days and feel like they weren’t wasted. I’ve been re-listenning to my Pro Tip series with Jenny Smith to brush up on my T1D management skills. I’ve picked a few books to read and I think that I may have an idea for bolstering the community around this blog and podcast.

Last two things: Those of you who aren’t able to stay home, please be safe and for anyone who feels uncertain about the coronavirus and what you should and shouldn’t be doing, I just recorded a very easy to follow conversation with Adam Naddelman, M.D. on the subject. Adam will be back on the show as events unfold.

Talk soon.

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Precision Xtra Blood Ketone Meter

It's that time of year... here come the sick days.

There are some things that you don't expect as you prepare yourself for parenthood. One of the things that I didn't imagine? Being peed on more times then I can count. I guess that I should have been ready for a little pee at the changing table or perhaps in the doctor's office. That said, I never imagined how many times I'd be hit while collecting a urine sample and I'm talking about pre-diabetes. There was a time when he was about three that I believed my son was trying to pee on my hand. And Arden, oh Arden is the biggest offender as she quite likes to break out into uproarious laughter as I'm bent over collecting a sample during her yearly well visit.

When I realized that checking ketones was a part of diabetes management my first thought was, "great, more to do and learn" but my second thought was, "well at least I don't mind getting peed on anymore".

Did you know that pee and ketone management don't have to go hand in pee covered hand.

Recently on FaceBook I had a conversation with a mother of a newly diagnosed child who was experiencing their first illness with type I diabetes. She was understandably concerned and wanting to make the next few days as stable and simple as she could. Without a moment of hesitation, I recommended that she get a Blood Ketone Meter and told her that we use the Precision Xtra from Abbott.

View fullsize

This meter is fast and accurate when checking ketones, it does require a largeish drop of blood but nothing that a little extra squeezing can't provide. It's a real lifesaver during sick days and any other times that you require a ketone check. I highly recommend asking your endocrinologist to write you a script so you can try it. We actually have two, one at school and one at home. I can't specifically speak to the pricing as our insurance covered Arden's meter and test strips, but I have seen the meter online for less then twenty dollars... a small price to pay to avoid getting peed on IMO. HUGE thank you to Erin who just told me in the comments that the meter is available for FREE from Abbott when you sign up for their FreeStyle Promise Program. Who says blog comments are dead?

When you love someone who has type 1 diabetes the flu and cold season is particularly stressful!

I know that during the winter months I'm always holding my breath a little extra, hoping that Arden doesn't get a cold or worse, the flu. There is much that you can do to prevent the spread of germs but getting sick is sometimes inevitable and being prepared makes the process go much smoother. If our Precision Xtra sits in a drawer 360 days a year – it is still well worth having for the other five.

May you and your children be healthy and germ free this season!

This post was updated with new links and better writing on 1/22/15.

Remember that I am not a doctor. I am just passing on good information from my perspective. Always speak with your health care professional before making changes to a care plan. This is not a paid review. Please note that I have never used it as a blood glucose meter and can't speak to it's reliability on that front.

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Kung Flu Fighting

So, what did you do this weekend?

Last Thursday evening Arden said, "I don't feel good" and just like that, we embarked on our second battle with the flu since Arden was diagnosed back in 2006. Two out of eight, that's... not bad, right?!

The timing of her illness (End of week, holiday) allowed Kelly to be the Super Mom that she is, while I got to take a more traditional Dad role - run to pharmacy, clean up, bring blankets and sleep in another room so Kelly and Arden could do their 'sick day lady communing'. I was happy to see Kel get this time with Arden but sad for it to come like this - they were both amazing and incredibly tough over the last few days. Being tired, sick and feverish sucks on a normal day but when you add type I diabetes and a holiday, well, it sucks a lot more. Moms always surprise me with their willingness to lay face-to-face with their kids when they are contagious. #MommyLove

Arden's BGs were more than manageable for the first twenty-four hours, actually they were fantastic - probably because she wasn't eating much. Since Saturday, they have progressively gone back to the normal level of challenging that we've come to expect.

All of this of course reopens the discussion about getting a flu shot - something we don't normally do. No one else in the house has the flu right now or had the flu this past winter, and even though Arden contracted the less aggressive strain (B), it is still difficult not to second-guess our decision. We are not an anti-innoculation family, but we do try to limit unnecessary medications. Actually, some years, the strain contained in the 'flu shot' never materializes in the population, but there is no denying that right now, it is tough not to wonder if we made the right choice. 

Arden is doing much better today and may make it back to school as early as tomorrow, she is already begging to play in her softball game tonight. We opted to use Tamiflu to shorten the life of her flu. The Tamiflu doesn't effect BGs and was strongly recommended by the pediatrician because Arden has type I. In all, it was a weird and wacky Easter weekend as Arden fought with this second wave of the flu season, prepared Easter eggs with a fever, and used up most of her adrenaline on Sunday morning trying to outrace Cole to the eggs hidden around our house. I'm not sure if we'll get a flu shot next year but this entire experience has led me to rename Easter to 'Fluster' - (Kelly nominated 'Fleaster' - but was outvoted last evening by our governing board).

Be well, wash your hands and let's hope that this all goes away as soon as possible.

C'mon Spring, get here!

I know what the FDA will say and I don't care

I've been sick since last weekend. It's mostly a head cold but it tried really hard to get into my lungs, I was able to fight it off and am feeling better today, but that's not the story.

Three nights ago it hit me the worst, I wanted, no I needed to sleep, but Arden'sBG was high and being very stubborn so I wasn't able to until about 2:30 am. On a day when I wasn't sick I'd take 2:30 with a smile, but like I said, I wasn't feeling good and so it was tough. But I survived. With about five hours of sleep under my belt, the next day drug on. I was a bit of a wreck if I'm being honest and my cold was doing it's best to advance into my chest. I needed sleep badly now, so I guess you can imagine what happened.

Arden got the cold too, now I knew why her BGs were so stubborn. She stayed home from school and we were sick together. But that night, that second night of my three night tale of woe, it was rough. BGs fought me like a bull and I wasn't able to lay my head down for good until 4:38 am, but I still had to get up at 7:15 the next morning. Now my ass was officially dragging. Every time I tried to sit down yesterday my eyes would close so I stayed busy doing household chores. When the evening came Arden was feeling much better, she didn't get it as badly as I did thankfully and I was hopeful about her BGs and my chances for some overdue rest. 

Before bed last night Arden's BG was a respectable 123 on her CGM, 140 with a finger stick and I was smelling sleep. I stayed up for another two hours to make sure she wasn't going to drop unexpectedly and sometime around 12:30 am I set a temp basal restricting her overnight basal rate because I knew I was going to fall to sleep and stay that way. It makes me nauseous to admit this, but I was happy to trade a waking 190 for seven hours of sleep.

This is what I woke up to.

Now I know what the FDA will say to my next statement and I don't care. We need something to help us. After a while you stop hearing the beeps and feeling the vibrations. Other days you may just be too tired or sick to react. For all that continuous glucose monitoring brings to the daytime, it just doesn't cut it after we lay our heads to rest.

Arden's DexCom receiver, your DexCom receiver should come with a dock, maybe it's an alarm clock too. I should be able to buy a companion clock for my room, for our living room, there should be an app. F&%king alarms and whistles and lights should blare in my ears and shine in my face. Hell I'd wear a bracelet that shocked me when Arden's BGs fell too low. Give me a Rube Goldberg that bashes me in the face, give us something... anything.

Now I am quite sure that the manufacturers of CGMs understand how much an alert system of some kind is necessary and this isn't the first time that I or others have ranted on the subject, but I am tired of hearing that, "the FDA won't allow that". I don't give a damn that each piece of tech that you add to a process makes getting clearance nearly impossible, just someone get the nerve to try. Walk defiantly forward and try to break new ground. Please.

Do it before I die of exhaustion, do it before Arden dies in her sleep. Do it before it decimates another life, another family. Be bold so we can not just live, but live better. Look closely at the next picture. Study the graph and then look at Arden's little face in the shadows. Imagine all of the people living with diabetes that are tired, battling a cold or just would love, absolutely f&%king love, a decent nights rest and then do something to help them.

I know what the FDA will say, they may say that if the signal is carried by my home WiFi for example then my home WiFi would need to be verified so it's not possble. They may say any number of a thousand things, but I don't care. Tell me where to sign my rights away. I promise I won't sue anyone if my router happens to stop working on the night my daughter's BG gets so low that it harms her. I'll take the chance, it's mine to take. Stop restricting great ideas from seeing the light of day because of what might go wrong. Something is better then nothing. Right? 

Seat belts aren't 100% effective, I still wear one. Condoms can't promise we won't get sick or pregnant, but we wear them because it gives us a better chance. This isn't just an issue for young children and their parents. This is also about husbands and wives, boyfriends, college kids, it's an issue that effects every person with diabetes and all we want is a fighting chance. 

Medtronic found a way around the problem with MySentry. Sanofi figure out how to link an app with iBGStar. It can be done.

Here is my unsolicited message to every company that has an idea that they are afriad to move forward with because of government regulations: I know you are scared to approach the FDA with innovation, I get it, I really do understand. But I'm afraid to sleep. I'm afriad that my daughter is going to die. People are scared that their wives, friends, mothers, sons will fall to sleep one night and never wake up. We win, our fear is worse then yours. Help us.