Inserting Levemir PenFills into NovoPen Echo

What do you do if your kiddo needs half unit doses of Levemir in on-the-go pens, but in the US the only thing available are pre-filled pens that only dose in one unit increments? 

 

You improvise!

Note: you will also need a spare or empty NovoLog PenFill cartridge to do this because you're going to steal a piece off of it.

 

Our Endo ordered per my request: Levemir FlexTouch Pens and a NovoPen Echo that has the ability to dose in half units. Then you do a bit of surgery.

 

1) Cut the plastic holding in the Levemir cartridge. I know people that do this with a utility knife, scissors or snips. I asked my husband to do it... thus a hacksaw got involved (overkill, but it worked just fine). Just cut very slowly until you almost get through the plastic and then just snap it the rest of the way by hand. Do both sides and the cartridge will pop right out.

 

 

 

 

2) The Levemir cartridge as-is is missing a piece to fit into the NovoPen Echo. All you need to do is to pop off the orange cap from a NovoLog cartridge and pop it right onto the Levemir cartridge. Now it will fit right into your NovoPen Echo.

 

 

 

3) I have multiple NovoPen Echo's in use so I label them using NovoNordisk's color coding system to keep things straight. I used green electrical tape for this.

 

 

 

Now I have a small handheld case that holds: full strength NovoLog, diluted NovoLog, diluted Regular, and Levemir.

 

 

 

We still use vials and a syringe at home, but having all of these insulins in this case right in the fridge makes grab and go crazy easy.

 

It doesn't take much to make this T1 Mama happy! 

 

Diluting ~ Sterilization Liquid

Something to think about when diluting insulin.  When you buy empty, sterile vials to dilute into they will always have a little liquid inside left behind from the sterilization process.  It's completely normal and not harmful.  

But the point of diluting is to be able to do corrections with as much accuracy and consistency as possible, right? For this reason, I always draw out the sterilization liquid before I dilute.  Sometimes I get very little out (usually just a few units), but today I just drew out 18u of that liquid.  😲

While I don't know that this would have made a huge difference had I not removed it, I'd rather not find out. 😉

Dexcom G6 Sensor Cover

 Wanted to share a cool little gadget I found on Amazon to help change overtape easier on G6 sensors. Put the senor/transmitter on like usual. Then you put this little plastic shield on (it's not sticky...it just sits on top). Then you put the overtape on. Samuel went his usual 5 days before the edges start lifting, but the overtape peeled right off and the sensor tape looked perfect underneath.

The 1st time we see used the free, clear overtape provided by Dexcom. It's barely bigger then the shield, but it still stayed on for 5 days. (Samuel isn't an athletic kid though!) He didn't like seeing the shield through the tape, so next time we used a nude patch which covers it better too.

Diluting Insulin Pens

Trying something new with Samuel. We haven't used an insulin pen in about 9 years and honestly I'm pretty opposed to them for super-low doses (due to inconsistencies when tested). With that said, I'm looking for an easier way to dose insulin while we're out. But I also need to be able to fine-tune doses, especially correction doses. 

1) I color coded our pens with tape to match our home color coding system to keep things consistent. 

2) The Novolin-R Flex pen can only dose in 1 unit increments (boo!), but Samuel often only needs 1.5 units so I diluted our pen to a 1:1 ratio so I can dose in half unit increments now. 

3) A typical correction for Samuel is anywhere between 0.4 - 0.8 units so I diluted a Novolog pen to a 4:1 ratio so I can dose in 0.1 unit increments.

4) On the insulins that I diluted, I marked it as "diluted" on the outside of the pen and on the inside when you take the cap off just as an extra precaution.

And FYI, the Frio Duo cooler bag says it holds 2 pens, but 3 fit pretty well. Not sure I like the Frio so I have another small pen holder on the way to try also.

Where there's a will, there's a way, right?

Oven Baking Tip

🍞🌡️🍪‼️ Baking Tip  🍞🌡️🍪‼️

Did you know???  If you have the type of oven that beeps letting you know it's done pre-heating (let's say you set it to 350°), chances are VERY good it's not actually up to 350° yet when it beeps. In fact, I've NEVER had an oven that has been. My current oven is only at about 300° when it beeps...it needs another 20 minutes to get up to 350°. 

This is why using an oven thermometer is so important. A lot of people think they're not "bakers" because their baked goods come out gooey or they fall/collapse. But chances are good you're actually just under-baking them due to your oven temp.  You don't notice this when cooking because you simply let it go longer until it's done or browned. But baking is science/chemistry and oven temp is crucial to making that science work.

Also, if your oven temp is "off", did you know it can be calibrated to be correct?  Just Google how to calibrate your make/model oven and you can easily adjust it!

Oven thermometers are inexpensive... I have a double-oven and have one in each.

When In Doubt.... Retest!

I have one smart kiddo and glad I trusted his instincts.

Around 3:30 his CGM said 72 mg/dL, but dropping a little. I checked his blood sugar for a snack and his reading was...gasp... 26 mg/dL.  We looked at each other in shock for a second and I grabbed the liquid glucose post-haste.  He stopped me and said "no Mommy, I'm sure it's wrong. I feel perfect. I'm going to wash my hands and recheck!".

A lot of thoughts went through my head...

1) did I screw up his lunch shot that badly...is Regular peaking hard?
2) what will washing his hands do for a low??? 🤔
3) I hope he doesn't pass out while washing his hands!

He came back perfectly calm, rechecked, and he was 78 mg/dL.

WHEW! Holy moly!  Talk about getting a Mama's heart rate going!  🥴

But this begs the question... what can cause a false low THAT far off?  Just a bad strip?  I'm not sure, but I sure am glad I trusted him and retested.

Precision Counts

This afternoon Samuel was a bit high (127mg/dL) so I was thinking about how insulin I wanted to correct with.

OriginallyI was going to do 1.5u, but then thought that might not be enough. My husband was in the room and I mentioned I might do 2.0u and he was a little hesitant thinking it might be too much. But, he said "you're darned if you do, you're darned if you don't" so we compromised and I did 1.75u.

EXCEPT we're not talking about FULL units here. We dilute insulin to a 4:1 ratio so we are really talking about a difference of 0.3u vs 0.4u. So the compromise of "1.75u" was actually a correction of only 0.35u which ended up bringing him down to 76mg/dL (CGM leveled off there), which puts us in a much better position for his dinner bolus. Perfect!!  🥰

Our Process of Tweaking

I'm often asked how we fine tune and make adjustments. Sometimes it hard for me to answer...there are so many variables and I honestly know ours.  But there are practices that I feel all T1's can employ. 

One of those is to log your results.  You can't fix what you can't see.

Next, change only one variable at a time. If you increase your bolus amount and increase your pre-bolus time and you go low, which change caused it?  It takes longer to fine tune this way, but I feel you have the best ability to learn how all variables work together.

When Samuel goes through a hard growth spurt (as he is now) often both his basal and bolus needs change - definitely during the spurt, but often permanently changes after it settles down.

His boluses have changed quite a bit -  the amount and prebolus time.  We've been working on each meal and look at them individually.

Here are some general rules of thumb for how we adjust insulin:

*Fast spike, stays high: more fast-acting insulin
*Slow spike, stays high: more Regular insulin
*Spike, but drifts down: longer pre-bolus
*Drops fast, stays low: reduce insulin
*Drops, comes back up: decrease pre-bolus time

Sometimes adjustments are a combination of these tweaks, but one at a time.

Below is our past 12 hours.

Overall, good but we're still getting a spike after lunch.  We've adjusted his Novolog and Regular (independently) and feel like we have the dose right.  I've been increasing his pre-bolus time 2 minutes at a time.  Each day the spike gets less severe and smooths out on its own.  Today was a 24 minute pre-bolus. Tomorrow I'll increase it to 26 minutes and we'll see what that does.

This is a pretty casual process for us. We don't like highs or lows, but they happen. We log the result, try to keep our foods consistent, and try better the next day.  This process is what we're trying to teach Samuel as he grows up with this disease.

Color Coded Insulin

If you use several different types of insulin like we do, it can be easy to accidentally grab the wrong vial, and in some cases that could be deadly.

After 7 1/2 years of Type 1 Diabetes, we recently made our first "dosed the wrong insulin!!" mistake.  We're human and it's bound to happen. We monitored him diligently, treated to correct it, and it really wasn't too bad.  But after that, I decided to spend about 20 minutes on a craft project to help us visually see the insulin were picking up more clearly.  Especially when you're doing a 2am correction half asleep. 😴

I may end up redoing this, but for now I like it.  Three of the four colors match the colors on insulin box for consistency-sake.

I just used some basic office supplies and the boxes the insulin came in.

Here's to hoping we make AT LEAST another 7+ years before we do this again!

T1 Parents - Dates and Get-Aways for Self-Care

It's really easy for parents of T1 kids to get caught up in this disease.  Guilty as charged!  But I'm learning that it is SO important for parents to get away every once in a while together.  We need time to focus on on each other and our marriage/relationship.  My husband and I have been trying to schedule "Date-Days" every month or two.  We drop the kids off at our friend's house around 9am and usually get back around 8pm.  We don't go too far... we stay within about 1.5 - 2 hours from home.  And there is most definitely a lot of prep that goes into it, but it's worth it.  Here is how I organize our food and insulin for our Date-Day's.

Meals for Samuel and his sister are put in containers and labeled who it's for and which meal.  Snack are labeled also.  Shots are prefilled and labeled.  We make sure extra test strips, chewable glucose, liquid glucose, prefilled correction shots, and a Glucagon is sent.  Our instructions for the Glucagon are attached to it.

We have also let the kids stay overnight at their house twice.  This is obviously more nerve-wracking.  We've only recently gotten comfortable to try this.  I send lunches, dinners and all the same items as above.  She makes them breakfast of bacon, eggs, and I send a piece of my Rustic Faux-Wheat Bread and measured yogurt or coconut cream to add to what she makes.  

Our pre-arranged instructions were to call us if she EVER felt uncomfortable or if he went lower than 50.  And you know what happened?  He ran low all night (mid to upper 50's).  She ended up sleeping right next to him so she could administer glucose and keep an eye on him periodically.  But she was comfortable with it (she watches him many hours per week and deals with glucose during the day).  I honestly felt so bad, but she was great about it.  And I think it gave more more insight to what life with T1 is like.  

My system for overnights, is similar to Date-Day's, but I use a syringe case (from Amazon), with Post-It Note label for each shot.

Close-up of the syringe case:

Easter Baskets - 2019

Here's everything layed out to go in their Easter baskets for tomorrow.

Evie's...
Big bunny, 2 dresses, shower poof, bath bombs, nail polish, lavender soap, hot wheels, and an Extreme Dark Lily's chocolate bar (very low carb).  She also has a What's in the Bible DVD, but it won't arrive in time... whoops!

Samuel's...
Big bunny, 2 shorts/t-shirt outfits, hot wheels, What's in the Bible DVD, and a new baseball bat (obviously that won't fit in the basket), and an Extreme Dark Lily's chocolate bar.

That's it for the baskets.  Tonight we'll fill plastic eggs for their egg hunt with coins, a few dollar bills, stickers and small things like that.  We're taking our eggs to our friend and neighbor's house do our hunt with them.

We'll dye eggs as a family, watch an episode of What's in the Bible together, and we'll read aloud the story of Jesus's death and resurrection from the Bible.  🙌🙏✝️

It's going to be gorgeous tomorrow, so I'll probably grill something simple... chicken breasts and veggies maybe, but food isn't the main attraction of Easter at our house.

Low Carb in Nashville, TN

I was just in Nashville, TN for a week and found it an easy city to stay low carb in.  I ate in nice restaurants, bar-type restaurants, my hotel restaurant, mall restaurants and even a gas station when I was in a pinch.  All of them offered something I could eat.

I also drank a lot of coffee from a lot of coffee shops and every single one of them had sugar-free syrups/sweetener and didn't bat an eye when I asked for my latte be made with heavy cream or half and half.

Here are a few of my favorites...

Grilled Salmon with pureed butternut squash and charred brussel sprouts.

Some days I work from secure facilities where I have to be metal detected and have bags searched.  I dislike having to leave just to go through that process again.  So I always take LC snacks in so I don't have to leave.  I also had jerky, but forgot to take a pic.

Seafood stuffed tilapia with grilled shrimp and a cream lobster sauce.  It was amazing!

Hotel room service of beef brisket chili with no beans.  Topped with cheddar cheese and dill sour cream.

My hotel had an omelet bar.  I watched the person in front of me get theirs made and the egg mixture clearly had some sort of batter in it.  This is a restaurant trick to make omelets light and fluffy. And full of hidden wheat and carbs.  I asked for my omelet to be made with fresh cracked eggs, which the cook had handy right at his station.  Sausage, bacon, pepper, tomato omelet - yummy.

My co-worker and I checked out a winery where we got a block of gouda to go with our wine.  Great light snack.

Grilled chicken sandwich - no bun - topped with melted gouda and aioli.

I had some really good coffee in Nashville.  This was one of the prettiest from a coffee shop in the Gulch.

I went to a cool restaurant downtown that made me a craft whiskey sour that I asked to not be sweet. The bartender did a great job - beautiful and tasty.

And at that same cool restaurant, I got a delicious salad with strawberries, pecans, feta, red onions, and blackened salmon.

Over-easy eggs with chipotle sauce, lots o' bacon and sausage.

This day I was driving in a 3 vehicle caravan and we only had a few minutes to stop for lunch.  Look what I found at a rural gas station in TN!  Pepperoni, cheese, almonds, and a hard boiled egg.  Add a diet soda and I'm all set.  Score!

Grilled chicken smothered in cheese and mushrooms and southern style green beans.

I had a great time in Nashville.  Every time I travel, I'm convinced more and more that staying LC can be easy peasy!  Happy travels!

Our Journey in a Snapshot

One of the things I'm asked most often by parents of newly diagnosed T1 diabetic kids is what our journey looks like.  I break our journey into 3 phases (red, yellow, green), which I've outlined on this 7 year long graph of Samuel's A1c history.

Each phase was an important stepping stone to the next.  I wish we hadn't gotten stuck in the middle (yellow) phase for so long, but at the time we were in our Low Carb journey completely on our own (no online support/groups), but I don't regret the phase.  It was an important way for us to learn.  I have to see WHY things works - either for the good and the bad.

Part of the reason I feel like we have such good control now isn't because I read a book [Diabetes Solution] and it told me what to do (although that WOULD work if that is how you learn!).  Our control is because we know what NOT to do because we tried doing "our" version of Low Carb.  After about 2 years of not getting the results we wanted, we re-read Diabetes Solution and binge watched Dr. Bernstein's Diabetes University videos on YouTube.  We buckled down and made massive changes to follow the book/videos.  That is result you see in the consistency in the 3rd and final (green) phase of the graph below.

No super mom/dad powers.  No rocket science. No quantum physics degrees.  Just a mom and dad that took a while to realize the book they read was spot on and decided to follow it with only a few exceptions that we don't feel are "core" deviances. ❤️

Valentine Glucose

Sweetarts Valentine Hearts are in stores now that work great for treating low blood sugar. The first ingredient is dextrose (aka glucose) which will bring blood sugar up faster than any other form of sugar because the body doesn't need to convert it before using it.

These are a little bit bigger than regular Sweetarts or Bottlecaps (I put a Bottlecap in the pic to compare).  Based on weight, each heart is about 1.3 carbs.

Quick & Easy: Chili & Cold Sides

Easy dinners are a must for us.  After working a 9 - 5 job the last thing I feel like doing is starting a complex dinner.  But compromising the health of my family, especially my T1's blood sugar, is never an option.  This is why I'm such a huge proponent of making things in big batches.  Which made up most of tonight's dinner (and every weekday dinner).

On Sunday, I made a huge pot of LC chili... about 8 lbs of chili to be exact.

I also have about 18 deviled eggs in the fridge (whites split and the yolk mixture in a zip-top bag with the corner cut; then just pipe the yolk into the egg white as you need them).  Instant Pots are awesome for hard boiled eggs!

I have about 2 lbs of carrot & "apple" salad made.

The only thing I had to add to this dinner was a cup of pre-made guacamole and some bell pepper sticks.

This was all thrown together quicker than Samuel's 20-minute pre-bolus.  💪

McDonald's... In A Pinch

I try to avoid fast food. And I don't like eating in my car, but I have a bad habit of not eating while I'm out shopping and then I get too hungry. And getting too hungry leads to bad decisions.  So I often bring a Smartbun with me... just in case.

And today, I needed that "just in case" Smartbun.  I ran through McD's and ordered a triple cheeseburger with no bun and then just plopped it on my Smartbun.

I had a fast, $3 lunch (including my Diet Coke), with about 5 net carbs.

(Another option would be to buy 1/4 lb of lunch meat while you're shopping and grab a couple packets if mustard/mayo deli's usually put out and voila... instant Smartbun deli sandwich.)

Low carb... The Tables Are Turning

I usually cringe at most diabetes magazines.  They're loaded with typical "eat whatever you want - you'll be fine" mentality.  I was pleasantly surprised by this recent article in Diabetes Forecast stating a low carb, even ketogenic, diet for diabetes control may be a smart way to go.

A few years ago people thought following a low carb diet was going to cause the sky to fall and it was most definitely a fad - all the while often not realizing that low carb was THE way doctors treated Type 1 diabetes before insulin and even up until about 20 years ago. It's been around for well over a century and to my knowledge the sky hasn't fallen once! It's only been since the development of fast-acting insulin that the medical mindset changed [for the worse in my opinion].

We've been low carb for 6 of Samuel's 7 years as a Type 1 diabetic and would never, ever consider go back to high carb.  We've been down that road and it took us several years to undo the damage it did.

One note I want to make is that the article mentions high fat, moderate protein which a lot of keto folks do.  However, more science-based low carb/keto diets are moderate fat, higher protein, which is the model we follow and has given Samuel fantastic growth.

Link to the full article...

http://www.diabetesforecast.org/2019/01-jan-feb/what-you-need-to-know-about.html#.XCVpnQddw84.link

Test To Be Safe

Samuel had an Endo appointment last Monday and we ended up running errands all day. We stopped at Ruby Tuesday for dinner because its easy on his blood sugar and consistent.  He gets a plain chicken breast, grilled zucchini, and the garden bar where he mostly gets raw veggies, baked cheese crisps (like Moon cheese), and sunflower seeds. 

I had a Diastix out that I was using to test my Diet Coke (that he was also sipping on).  Midway through his meal he asked if he could use a Diastix to test his zucchini. I wasn't sure if he'd remember how I test food for glucose, but sure enough, he did it completely on his own.  {Proud Mama moment!}

From asking before, I know the zucchini is grilled with a butter sauce and I tell the wait staff no sugar (just to be safe), so I expected no glucose detection, but guess what?  There was some reaction to the Diastix - just a bit, but it was visible.  He didn't spike so I'm sure it was the same as always... I was just surprised because I had never tested it. 

I was so happy to see him take the initiative and see how important it is to know for sure and not assume something is safe.  And he was so excited that he thought to test something that Mommy hadn't!

Thanksgiving! Have Food; Will Travel

Happy Thanksgiving to those in the US!  This is the first year since Samuel's T1 diagnosis that I haven't hosted Thanksgiving at home.  Today we're going to my sisters house. I don't expect anyone (family, friends, schools, churches, etc) to accommodate our lifestyle. Type 1 diabetes is our burden and managing it via low carb foods is our choice.

To make this work (I hope!) I bring everything we'll need to enjoy the festivities and stay low carb.  I bring a little extra for people to try, but not enough to overshadow the work that my sister is putting into hosting.

Here's what we're bringing along:

Fried "Apples" (aka zucchini)

Mashed Cauliflower

Turkey Gravy

Stuffing (using my Rustic Faux-Wheat Bread)

Candied Nuts (Walden Farms 0 carb syrup)

Pumpkin Cheesecake Pie

I made everything on Wednesday and packed it up in spill-proof containers.  I also have a jar of Walden Farms cranberry sauce and some sugar-free whipped cream for the pie.  We're all packed up and ready to go!

We hope everyone has a happy, healthy and safe Thanksgiving!