Sunday, January 10, 2010

Rocky Mountain High Blood Sugar

Today is January 2, 2010. It sounds like a date in the future, but it's my New Year's Day since yesterday didn't didn't really count. It was just a blur of cold fingers and toes, luggage, and airports, as we made our way home from Steamboat.

We've taken a few trips with the kids over the past year: New York for theater and museums, Las Vegas and the Grand Canyon, the Bahamas, four times to Florida. All places with reliable cellular service; pharmacies and EMS easily accessible. This was our first "extreme" vacation since Maya's diagnosis with type 1 diabetes 17 months ago.

We decided to take this trip at the last minute, which, thankfully, allowed me relatively LESS time to obsess. Amidst preparations for Santa's arrival and Christmas house guests; while outfitting a family of four for exposure to freezing temperatures; as we frantically replaced snowboards, bindings, and boots that the boys in the ski shop thought worthy of an antique store, I was silently consumed with everything that could possibly go wrong. (At least I HOPE it was silently! Was I AUDIBLY blathering my doubts about taking a 4-year-old with diabetes onto a freezing mountain slope, which may or may not have 3G coverage, to practice a strenuous sport for the first time? I honestly can't remember.)

Does altitude affect blood sugar? Does exposure to extremely cold temperatures affect blood sugar? How many extra carbs does a 50 pound child need during a day of skiing to keep glucose levels from plunging? Or conversely, will the adrenaline rush of skiing keep her glucose levels too high, requiring extra insulin? Which kid-friendly protein snacks are easy to take along and feed a 4-year-old, while wearing thick, insulated gloves? How do I keep test strips, Glucagon, and insulin safely between 36 and 86 degrees? After a couple of frustrating conversations with the office of our pediatric endocrinologist, I posted inquiries on FB and several diabetes sites. Surely someone had taken their diabetic child skiing and would offer up some advice. Yet on the day before our departure, I still had no useful answers to any of my questions.

Day One: Checked Lucca into snowboarding school, Ricardo headed up the mountain, and I hovered around the Kid's Club, checking blood sugars, bolusing insulin, watching Maya in her skiing lessons, amazed at how quickly she went from Level 1 in the morning to Level 2+ by mid-afternoon. I guess altitude and freezing temperatures don't drastically affect blood glucose levels; she did great all day long!

Day Two: Checked Lucca into his second day of snowboarding school, where I'm pretty sure he was already better than me. Ricardo headed up the mountain, and I again stayed close to the "Magic Carpet" lift where Maya was having her ski lessons. Fueled by yesterday's success, I felt secure enough to venture out a little. There wasn't time between blood sugar checks to snowboard, but I did manage to shop a little and tour a beautiful new ski-in, ski- out property, conveniently located right next to the Kid's Club. After 2 days of lessons, Maya was a level 3 beginning skier; Lucca had mastered the chair lift and was working on his toe edge turns. I was happy that diabetes had so far not been an issue, but feeling a little restless.

Day Three: Ricardo stayed with Maya so I could spend the afternoon on the mountain with Lucca. The last time I was on a snowboard was 10 years ago when I was pregnant with Lucca. I was a little (read alot) worried that I would spend more time on my back than on my board, but things went really well and we had a great time! Things were going so well, in fact, that we decided to try going up the mountain as a family...

Day Four: I was feeling happy and confident as we headed up the mountain; even if a little worried that I might not be able to kick my board off quickly enough to help Maya navigate her way off the chair lift for the first time. Since childhood, I had always had this vision of my adult self, with my family, on top of a mountain covered in snow; it seemed as if that scene were about to manifest. Exit lift, kick off snowboard, run to help Maya. Maya exits lift like a pro. Lucca takes off down mountain. Ricardo and Maya take off down mountain. I sit to strap my bindings to my boots, stand, fall flat on my ass. And then the panic starts. Lying there in the snow, mini-backpack full of temperature sensitive supplies beneath me, I realize that although everything had been going very well diabetes-wise, I had yet to spend a full day outdoors with them. And they had never been buried in the snow with me lying atop them as they now were. I'm not sure if it was the panic, or as Ricardo suggested, the new snow that had fallen the night before, making for a more unpredictable descent. Either way, I spent MUCH more time on my back that first run than I had the whole previous day. At the bottom, I was totally freaked out, worried about the diabetes supplies, and upset that my morning of snowboarding was over.

Ricardo and Lucca went back up the mountain, while Maya and I headed to the lounge. No sense ruining everyone's morning. So I had a couple of hours to come up with a solution before meeting the ski instructor we had hired to spend the afternoon with us. The most obvious way to keep the supplies warm was with body heat, but I just couldn't figure out the logistics. The items were just a little too long and bulky to fit safely and comfortably inside my jacket; especially if I were going to spend so much time in a prone position. Then I had another idea. Before meeting the instructor at 12:30, I activated one of those wonderful little 7 hour hand warmers Santa had put in our Christmas stockings, and threw it into the bottom of the mini-backpack.

I have no idea whether this system worked or not. Maya and I had a wonderful, if unpredictable afternoon. Greg, the ski instructor, was amazing with Maya; truly a man who has found his calling. Having him along freed me to concentrate on keeping myself in an upright position without worrying about Maya. And Maya was navigating the chairlift and the "secret" trail through the pine forest like a pro. The first time I checked her blood sugar, after only half an hour of skiing, her blood sugar measured 54. Greg was very understanding and helpful as I went through a 20 minute mountain top ritual of glucose tabs, recheck, protein snack to get Maya back to a safe level. While we waited to recheck, Maya made snow angels and I enjoyed the heavenly view from 9000 feet above sea level.

I continued to check her every half hour throughout the afternoon, just to be safe. When it looked like she might be going low, I gave her a Hershey's Kiss to suck on, and sent her off down the mountain for another half hour of flying blissfully down the mountain.

Maya was so tired that, even in her excitement to get to the hot tub, she was asleep almost before I could get her swimsuit on her. When I checked her blood sugar level as she slept, it was 467. HOW DID THAT HAPPEN?!?!? Had the extreme temperatures rendered the insulin I had given her useless? Was it a delayed adrenaline reaction? Was it the emotions of the tantrum she threw when I made her take her skis off for the day? Did the hand warmer get too hot in my backpack?

Of course, we immediately trashed the insulin vial that had gone up the mountain with us, just in case. I corrected for her high minimally, with a new vial of insulin, as I was unsure exactly what was going on; and continued to check her at half hour intervals as she slept until everything was back to normal.

Is giving a child with diabetes chocolate while she skis the ideal solution to low blood sugars? No. Did our day go exactly as planned? No. But I did have a wonderful, unforgettable afternoon with my daughter on top of a mountain, with snow falling all around us. Maya learned to love a sport that I am sure she will practice for the rest of her life. And we both saw that with a little planning and precaution, she can do ANYTHING! Life is good.