Number Thirty Seven

Have you ever heard that if you ask a person to name a number between one and one-hundred, the most common answer that people give is thirty-seven?

I don't know if that's something that can be proven mathematically but I have noticed it a lot over the years, that number just pops up all of the time.

Arden's All-Star softball team competed in their All-Star tournament last week. They played their first game on Thursday night and lost. Friday was rained out so they were scheduled to play two games on Saturday but they couldn't lose again or they would be out of the tournament - you can only lose two.

Thursday's game required a large bolus to battle Arden's adrenaline and the same was needed for the first game on Saturday. They won that first game Saturday and after a thirty minute break to recharge, they played again. During that second game her BG held steady until about the fourth inning. Arden's DexCom CGM was hung on the fence of the dugout during the games and I would check it every inning or so depending on how her BGs were acting. Arden ran out on the field when the forth inning began, as she did I walked into the dugout and looked at her CGM. Her BG was 120 with two arrows pointed down, she was falling fast but I knew that a juice box would handle it. I was actually waiting for this fall. Arden ran in to the dugout, drank a juice box in about ten seconds and ran right back to third base. Her BG balanced out as I expected and the girls won the game about an hour later. When Saturday ended, the team was 1 and 2, and scheduled to play again the next day at 1pm.

Arden's BGs were on the low side overnight, as I expected they may be and I handled them with a little juice and some temp basals. Nothing out of the ordinary after a day of activity.

Sunday brought high temperatures and a clear sunny sky, it was very hot. The girls warmed up at twelve-thirty, the game began at one and the adrenaline hit her about 45 minutes later. I bolused when her BG began to climb but I was too late, Arden's BG was on the move. I tried desperately to get it to come back down without going to low. Arden has trouble running when her BG gets above about 200 - she is normally very fast but above 200, her speed and dexterity become average, so my goal is always to keep her under that number when she plays. They won the first game and the next game was going to start in a half an hour. Arden's BG wasn't moving but I still only gave her a slight bolus (.20) for all of the food that she ate after game one. I thought that the .20 was a conservative approach to her game break snack as I was still leary of a fall from the earlier adrenaline bolus. 

We were now into the second game and my plan was to check her CGM after the third inning. The last time I looked at it was before the second inning began, it read 192 with an arrow diagonal down. Before I could get up after Arden made the last out of the third inning, she ran through the gate toward me holding her hands over her head and gesturing for me to come to her...

"I feel really dizzy!"

I didn't bother to test before I handed her a juice. She sucked it down as I tested her free hand...she was 37.

I said to Kelly, "Give her another one" as I ran to get the CGM from the fence. Arden's BG was dropping so fast that the CGM hadn't caught up yet, it read 101 but now both of it's arrows were pointed down. Arden's BG was falling way too fast, she drank two juices, ate a fast acting tablet and was now chewing on a handful of Mike and Ike's. I tested again, BG was 49 and she was still very dizzy.

Arden and I went into the dugout to get out of the sun, she alternated between sipping cool water and fuetly holding her head to try and stop the dizziness - seeing her press her hands into the side of her head broke my heart. I hugged her as she laid into me, I quietly told her that it would stop soon. We tested again, 69 but the arrows on the CGM were still pointed straight down. I decided to follow what the meter was indicating, I believed that her BG was climbing and stoped considering more carbs. It was then that Arden's place in the lineup came up... it was her turn to hit. "They can skip you for one inning", I told her.

"I can hit", Arden stood up squeezed her head between her hands one last time and put her helmet on, we tested again and her BG was 131 but she was still feeling the low. What came next was Arden's only strikeout of the tournament. She fouled off two pitches, running them both out before swinging and missing the last pitch of her at bat. I sat in the dugout staring at her, I was sure that I shouldn't have let her hit but I just couldn't find the parental wisdom in telling her that diabetes was going to make her miss that at bat. Secretly, I was so happy that she didn't get on base because I didn't want her to run but you can't imagine how proud I was of her for trying. She sat out the next half inning, opting to lay on the bench with her head on my lap so she could try to get her bearings. She only said two things to me during that time... "It's getting better" and " I can't believe two balls went to my position". She was annoyed that she missed the opportunity to make two plays.

When her team made the last out, she sat up, looked at me and said, "I'm okay, go back with mom".

Arden and her team went on to win that game and then they won the next one too. They never lost after losing the first game on Thursday and they won three in a row on that hot Sunday afternoon. I'm still not positive that I should have let her hit but, well, check this out...

 

That's Arden holding her trophy. Her team won the 2013 eight year old All-Star tournament last weekend! She played all but three outs in the field and never missed an at bat. Arden beat all comers, including diabetes - I think that if I was any prouder of her... my heart would burst.

Exercise and type I diabetes blood glucose control

Arden followed in her brother's footsteps last week when she tried out and was selected to play on our town's all star softball team. Yea Arden! The girls have been practicing each night since and I am learning more about blood glucose control before, after and during exercise then could have imagined.

Her second at bat.

First thing I learned is that all of Arden's activities from the past don't put nearly the strain on her system that an intensive two hour practice/game brings to her. Arden experienced a latent low in the early hours of the morning that followed her first practice. It was nearly eight hours since that practice began when her BG suddenly dropped. I couldn't cut off the fall by suspending her basal so I woke her up to drink a juice box. Normally I can fend off lows at night with a temp basal, this was different, a more powerful drop. I was awake and ready for it because I expected it but if I hadn't been, there is no telling how low she may have gotten.

So the next night I was ready! I kept her BG a little high before bed and didn't cover a small snack after practice. This turned out to be a winning combination. Night two went well.

On the third night I tried to mimic the success from the evening before but it turned out that a new site on her leg wasn't working the way I expected. When I combined keeping her BG a little high with a small snack and a site that wasn't up to snuff, I got a high BG that wouldn't come down easily. Hindsight has me wondering if the leg site was perhaps less effective because of the large amounts of running that she has been doing, as they normally work very well.

After I moved the OmniPod to her abdomen the next few nights went as planned, however I had to put quite a lot of effort into keeping things balanced. These last few weeks haven't just proved to me that strenuous activity can cause a low but that high BGs effect athletic performance. I noticed that if Arden's BG gets too high that her speed seems to diminish (I hope that you can share your experiences with me in the comments about this). Normally a very fast runner, Arden couldn't perform as she usually does if her BG began to rise above 220. I think that I also saw a decrease in her hand-eye coordination during this elevated period.

Last night before her first game I tried very hard to keep her BG around 100 before game time. I added carbs as the game was about to begin, a few slow acting and about 15 grams of juice. I was hoping to keep her steady without going too high during the game. I was able to do this with a lot of help from her DexCom CGM and she never went above 190 but wow was it a lot of work... though totally worth it to see her have such a good time.

This first game didn't just teach us more about type I diabetes, it also gave us our first look at Arden's competitive nature in a sporting moment that she regards as very important. Arden took this game seriously, she had fun but playing well was definitely high on her list of priorities. It goes without saying but we are very proud of Arden and the extra effort that is required for her to participate makes that pride shine just a little brighter.

Your child can definitely play sports at a competitive level with type I diabetes, that fact was never in question. All you have to do is give the moment the forethought and preparation that it requires, it'll be tough at first and you may spend a night or two battling lows but once you have a system in place it's not unlike the rest of your days with diabetes. You can do this.

Have fun out there!

One of the two outs Arden recorded in her first game.