I happen to be pretty comfortable with numbers. I took four years of “advanced” mathematics in high school and did well with it, and I was a bookkeeper in my former life BC (before children). It took me a couple of months PDx (post diagnosis), but it finally occurred to me that when T-Bear’s diagnosing endocrinologist asked about my education, one of the things he was probably probing about was the level of my mathematics skills. Since it came easily for me, I guess I didn’t really stop to think about that too much. After all, I had a few other things to think about at that time, and for several months thereafter.
But, when I picked up an algebra workbook for myself at the beginning of our homeschool year and worked on a couple of pages (that’d be “Inspire, Not Require”), it dawned on me that I had been using and applying basic algebraic rules to calculate T-Bear’s insulin injections. Correctly, which is kind of important. Then I began to think about other parents with T1 kids, and how well they were coping with the mathematics involved.
I happen to know a few adults who suffer from “math block”, who never really recovered from that one horrible math class in which they became convinced they would never be able to do anything remotely mathematical, and that conviction has stuck with them their entire adult lives. And, what a completely horrific nightmare it would be for one of those adults if their child had T1. If their child’s health, and possibly very life, depended on math skills that they, the parent, just did not have, and were convinced they would never have. “Sink or swim” does not even begin to approach the trial-by-fire that these parents must endure. It made me deeply grateful, once again, for the brain that I have. This little mass of cells that easily grasps and manipulates numbers on an intuitive level. It makes me weep just thinking of it.
Now, Brother Bear, because his heart is so golden, makes efforts to learn how to care for his brother. He goes through spurts where he insists on drawing doses for T-Bear (under my supervision), and insists that I help him learn how to do the calculations. Honestly, the math is still a little complex for him at this point, but whenever he shows up for another round, we go through the numbers together. Because someday, I know, it’s going to click for him. And, when it does click, it’s going to be with him for the rest of his life. Because his brothers life and well-being depend on it, and he knows that. THAT is “living math”. Literally.
So, for those who have never calculated an insulin dose (lucky souls), here is a typical day in the life of our T-Bear, by the numbers. Keep in mind, this is the “easy and flexible” insulin program, and there are many other programs out there. And, we're still on MDI (multiple daily injections), not a pump. This program requires more math, but allows for tighter control of BS, particularly for kids whose eating habits tend to be somewhat irratic. And, tight BS control is a good thing. A very good thing. Really, an essential thing. And, BTW, I don't guarantee all of my math is correct...just "close enough".
2 c whole wheat flour = 46 g carbs
3 tsp baking powder = free
½ tsp salt = free
¼ c sugar = 12 g carbs
2 eggs = free
2 tsb oil = free
1 ¾ c milk = 21 g carbs
Total carbs per batch = 79 g carbs, yielding 4 cups of batter
¼ cup batter for one small pancake (4 c / 16) = 4.9 g carbs
2 pancakes = 9.8 g carbs
¼ cup syrup = 53 g carbs (really….wow…look at THAT compared to the pancakes it goes on)
1 egg, scrambled = free
1 c milk (to drink) = 12 g carbs
Total breakfast carbs = 74.8
Pre-breakfast BS = 101 = no correction needed
Meal = 74.8 g carbs / 15 (carb/insulin ratio) = 5 units
Total breakfast dose: 5 units fast-acting insulin
Sub sandwich from Jen's NY Deli (park day):
6” sub bread = 48 g carbs (thanks, Jen, for looking that up for me)
Turkey, ham and cheese = free
Mayo = free
Lettuce & tomato (which he picks off) = free
Pkg potato chips = 23 g carbs
Bottle of Crystal Light drink = 0 carbs
Pre-lunch BS = 163 = (163-100)/50 = 1.25 correction
Meal = 71 g carbs / 12 (carb/insulin ratio) = 5.9 units
Total lunch dose: 7 units fast-acting insulin
Apple (small, but have to guess exact carbs) = 15 g carbs
Peanut butter = free
Pre-snack BS = 85 = no correction needed
Meal = 15 g carbs / 12 (carb/insulin ratio) = 1.25
Total snack dose: 1 unit fast-acting insulin
1 box organic tomato soup = 4 servings x 16 g/serving = 64 g carbs
1 jar organic marinara sauce = 4 servings x 42 g/serving = 168 g carbs
6 oz elbow macaroni @ 2 oz/serving = 3 servings x 42 g/serving = 126 g carbs
1 c frozen vegetables (don’t count, ‘cause he’ll pick ‘em all out)
Total pot = 358 g
Portion size (approx 1/5 of pot) = 71.6 g carbs
Fresh French bread (guestimating ‘cause there’s no nutrition label) 2 slices @ 15 g per slice = 30 g carbs
Pre-supper BS = 75; anything under 80 requires correction, so approx 10 g carbs free
Meal = 101.6 g carbs – 10 carbs free for correction = 91.6 g carbs / 12 (carb/insulin ratio) = 7.5 units fast-acting insulin
7:00 pm = 10 units Lantus (slow-acting, 24-hour basal insulin)
Not hungry, so doesn’t have a snack (thank goodness)
Pre-bedtime BS = 80; needs to be over 100 before sleeping to avoid overnight lows (we really do NOT want to go there, 'cause it can involve seisures, stabbing with glucagon, and calls to 9-1-1), so force down one cup of milk; no fast-acting insulin needed.
So, that’s kind of it. A day in the life of T-Bear, by the numbers. Thank goodness for math, and for a brain that can do it fairly accurately.
PS: BTW, since I drafted this article, T-Bear's insulin/carb ratios have been tweeked. Just when I get all the numbers memorized (which is NOT my strong suit), they get changed.
PPS: One of the things I am deeply and daily grateful for is NO overnight lows. At least I can sleep at night knowing T-Bear is okay. Most nights. I weep for the parents who have to test their kids' BS at 2:00 am every night and correct, just to keep them okay. Juvenile Diabetes is a living nightmare for too many families. We need a cure NOW. PLEASE help if you can. JDRF.