Keeping Watch

Murphy's Law: Jessica's blood sugars will choose the seven nights I am on duty alone to go completely haywire. I freakin hate Murphy's Law. I am exhausted. Utterly and completely exhausted. In diabetes defense, it is not entirely the blood sugars' fault I am so tired. I sometimes wonder how much medical school and residency have molded me in how I care for Jess. Do I worry about different things than other parents because I have seen so much? Am I harder on myself as I have been exposed to years of hearing about the "non-compliant diabetic?" I know it is because of my medical training that I try so hard to empower Jess---to make this her disease as much as it can be a 9 year old's disease...to teach her and let her make as many decisions about her own care as she can. It is also my medical training that leads to me sleeping horribly when I am on my own with her. A common feeling among my friends in residency was the huge PHEW you felt the morning after call when an unstable patient had not died on your shift. This feeling really can not be described unless you have experienced it. I remember so vividly sitting apprehensively multiple times during residency and getting "sign out" on unstable patients that might not make it through the night. I would count down the often 24 or more hours I was on call as I kept such a close watch on these patients. I absolutely did not want the patient to die on my shift. Obviously, I did not want the patient to die at all...but every resident I knew would breath a sigh of relief when they could sign over these unstable patients and go home to rest knowing they had done their very best and the patient was still alive. In some weird way when I am alone at night with Jess these memories and feelings return. When the hubby and I are both here at night the responsibility is shared. If I don't hear her Dexcom alerting us that she is low then he might. There is back up. But, when I am alone I am transported on some level back to residency. Jess is my only patient and I am on call every night. And, God dammit, nothing better happen to her on my shift. The "dead in bed syndrome" haunts me when I am alone at night. I wonder for the millionth time why she does not wake when she is low. I simply can not fathom going in her bedroom in the morning and finding her dead. I can't imagine ever recovering, nor can I imagine living the rest of my life knowing that I was the one here alone when it happened, and that I failed to keep her safe. This would be the ultimate failure as a parent and as a physician. It is like her pancreas knows my fears and taunts me. One night this week she was high all night. She had ketones. Jess pulled out her site to check as we were both sure it was kinked. It was completely fine which led to her crying and saying "Daddy inserted that site...I want daddy to insert my site." Of course, she knew he was at the hospital and couldn't. I reassured her that I do kick butt site changes and thankfully we did not hit a nerve. She continued to run high and for the life of me I could not figure out why. The next night...lows. So much scarier for me then the highs. I no sooner would treat a low and give a snack then the Dex would be going off again to alert me she was falling fast. This after a night of highs with nothing different. And two more nights with lows despite changing basal rates. Tonight I went to bed at 9 pm...simply could not stay awake any longer. I woke from a sound sleep to my hubby shaking me at 10:30..."I'm so sorry but you have to get up. Jess has been low three times and I've fed her so much she is refusing to eat. I have to leave for the hospital and you are going to have to recheck her." I groggily get up and put her in my bed for the 5th time this week. It is easier to check her without having to get up. I also have an unfounded theory that if she were to get low I would sense it when she is next to me. Or, I would wake if she had a seizure. At least I tell myself this is the case. And, so tonight will be another night of restless sleep and blood sugar checks. This "call" every night is killing me...in residency the most frequent I was ever on call was q2 (every other night) and there was time to rest in between. My days have been packed with my own patients and my daughters who need me to care for them. I am counting down the hours tonight until the hubby is finally off these seven days and my "shift" is done.

The Death of a Pancreas

Our journey with Jessica's diabetes has been unusual compared to some. Her diagnosis, while emotionally devastating, was physically easier than others. We were INCREDIBLY blessed that she was not sick at diagnosis---just simply thirsty. She will forever tell everyone that she "got diabetes in a McDonald's parking lot on the way to Shenandoah." I have often had some form of survivor's guilt as I have listened to others tell their diagnosis day stories. I realize how lucky we are in this regard, and knowing what we went through those first few months simply cannot imagine what others have gone through. Jess was on incredibly small doses of insulin for months. She used to take 1/2 unit of Lantus a day, and 1/2 unit of Novolog with meals. They thought perhaps she had MODY (a cluster of genetic forms some of which only require oral meds). She never had positive islet cell antibodies (a hallmark in Type 1). She never had ketones---not even at diagnosis when we found that the "critical high" on her meter was actually a blood sugar of 684. This gave me hope. So many of the potential areas of research are focused on stopping the body's attack on the pancreas and allowing the beta cells to regenerate. We were different I assured myself early on. Jess would continue to make insulin as demonstrated by her extremely low insulin requirements and lack of ketones. That cure might come. Maybe I needed this early on. I definitely wasn't fully ready to accept that this was it. This was how it was going to be. My "perfect" little girl surely could not be un-repairably flawed. I needed hope to survive that first year. Even though I continued to live in denial and tell myself that Jess's pancreas was only sick not dead, we did as we were told. We checked ketones with two unexplained highs on the pump. They were always negative. Of course they were I told myself. Her pancreas is still chugging along, just on a slower track than normal. But, of course, her rates climbed as the honeymoon ended. And, I healed. We all did. Diabetes moved to the back burner, instead of suffocating us with its glaring fire. Until one night the pump was forgotten by the bathroom sink. It was then we were given a true glimpse as to the well being of Jessica's pancreas. She awoke nauseated and having to pee...and, the ketone meter declared her pancreas's death. Large ketones. A working, living pancreas does not allow large ketones to be made. I paused as hope shattered. But, the pain I expected wasn't there. A bit of an ouch perhaps, but not the deep heart wrenching pain I had anticipated. Time had shown me that I still have my "perfect" little girl. Only she's not as little. She's bigger, stronger, more resilient, and simply my hero. And, although I would give anything to revive her pancreas she's absolutely "perfect" without it.

Humility

One of the things that has been a positive about Jessica's diagnosis is the fact that I would like to think it has made me a better family doc. I have never lacked empathy, but at times I have lacked patience. I would be lying if I said there weren't times when I have been frustrated by my patient's "non-compliance." I hate that word..."non-compliance." What does that mean anyhow? Life is complicated and busy. People are humans incapable of perfection. And, taking care of one's health is HARD! The nice thing about Jessica's diabetes (and I can finally see so many nice, good things) is that it keeps me humble. Case in point: Last night the hubby checked Jess before we went to bed. 122. Exercised all day. Dexcom currently broken and awaiting a new. Kid doesn't wake when she's low (the most terrifying thing as a parent.) So, Sean gives her a snack. I fall asleep and don't wake until 3 am. What I didn't know is that Sean had checked her at 11 pm and she was 300 and he had bolused her. I check her. 340. Wow, that must have been some snack. I bolus her and go back to bed (I was only ever half a wake anyhow!) The ping has a remote which I love. But, we discovered its flaw last night! Jess wakes at 6:30 am as she has to "pee really bad." I check her again and she is still 340. That's weird I think...better check ketones and her site. LARGE ketones. Holy shit! The kid never has ketones...she didn't even had ketones at diagnosis. Once with a kinked site she had small ketones...but LARGE? I unzip her one piece pajamas to check her site, and pull it in preparation of inserting another. Jess realizes before I do..."my pump isn't on. Oh no---I forgot to put my pump back on after my shower." Apparently the pump was in range of the remote so we were bolusing the bathroom sink all night. The blame starts. In my head...I am blaming myself. I suck. I am a terrible mom. In my head I blame Sean...if she was 300 why didn't he wake me to tell me so I would have known the history to the 340? But, before I can even voice any of this, there is my nine year old daughter out loud blaming herself. "How could I do this?" she says. "I'm so stupid...I can't believe I did this." Whoa...stop.... I tell Jessica (and myself in my head, and my hubby who I am sure has been having the same self blame thoughts)....if we are to blame anyone...blame diabetes. If we are to be mad at anyone, be mad at diabetes. "Normal" people don't have to remember to "plug" back in after showers. It is diabetes's fault she must now remember. We are human. We are not computers. We make mistakes. She has had the pump over a year and this has not happened before. It was a multi-system breakdown, but we are each but a human. I guess we were "non-compliant" last night. But, life is messy. Life is busy. And, we are not perfect. My patients' have messy, busy lives too. I'll once again remember that when they are "non-compliant." And, Jess is fine. The ketones cleared within a couple of hours and she returned to her messy, busy, non-perfect life.

Better Late Than Never

We attended our first Children With Diabetes conference this weekend. To say that it was an absolutely amazing would be the understatement of the year. It was like going home. It felt as though we were welcomed into this huge amazing family with open arms.

Jessica has struggled deeply lately. Although in retrospect it makes perfect sense, I did not realize that it is partially because she has entered a new developmental stage. When an adult is diagnosed with a chronic disease they are, for the most part, done developing. Children continue to work through the developmental stages. So, what diabetes meant to Jessica at age 7 is very different than what it now means to a 9 1/2 year old. She has been processing and mourning what the diagnosis means to her at this age, and it has been a bumpy road. Add her major growth spurts and pre-pubertal hormones into the mix and the high blood sugars have made her even more miserable. My heart has ached for her, and I have been more than a little frustrated at taking the burden of many of her outbursts. She has told Sean and I often that we don't know what it feels like to be her. She is absolutely right. And, so we registered for this conference hoping it would help. Jessica was not excited to go Friday..."why do we have to go to this conference? I know I'm not alone in having diabetes...why do I have to go see other kids with it too?" But, we drove to Conshohocken (I kid you not...that is really the name of the town!) and made it to the hotel late Friday night.

Within an hour of the conference starting I knew we had done the right thing by coming. There is simply nothing else like spending time with other families who in this one area are living as we are. We saw old friends and met so many new. We all share the same language, we all know the emotions, the roller coasters, the highs, the lows, the fear, the pain, the hope...it was like being surrounded by so many kindred spirits.

The day was packed with lectures for the grownups, while the kids were in their own sessions. My mind spun from the graphs, the equations, the massive amounts of information being thrown in my direction. My heart ached from hearing others diagnosis stories, and bled from talking with the newly diagnosed. I am not yet so far out from Jessica's diagnosis that it does not cause physical pain to think about it, and to see others in such pain. But yet, I was able to tell them..."It gets so much better." And, it has. It so completely has.

I met so many absolutely amazing kids. Kids that were diagnosed at 8 months, 12 months, 2 years. Kids that were diagnosed the same age as Jess. Kids that were diagnosed older. All of these amazing heros who prick their little fingers multiple times a day, endure injections and site changes on their small bodies, brave highs and lows even when some of them are too young to even understand why they feel this way. They are not without fear or anger. But they are resilient and brave, and above all else they are kids.

I met adults living with Type 1 who were inspiring. They give me hope. They comfort Sean who has lived his life with Type 1 in relative isolation. Getting diagnosed at almost 18 has its own pitfalls...he didn't have the chance as a child to be connected into the Type 1 community. There were so many awe inspiring adults with Type 1....it was humbling to be around them and to learn from them. I found myself swallowing tears multiple times as I watched with huge gratitude as they enveloped the Type 1 kids in hope and support. I watched as Sean experienced such comfort talking with them. He thanked me for registering that first night with tears in his eyes...he told me that he knew we did it for Jess, but that he needed it too.

I watched Jessica smile and run with her new buddies. I held back tears of comfort watching her and her friends check their blood sugars together. I laughed as she showed me a friends pump covered in duct tape (the new tween rage-duct tape?!) and tell me she wants to do that too---"Mom, isn't a duct tape pump cool?" I listened in complete shock as she told me "Mom, I might not take the cure if it comes...I actually am ok with diabetes," as she then fled off again with her Type 1 buddies. I watched proudly as she showed other kids her Dexcom...the very gadget that she only months ago refused to wear.

A group of us went to dinner last night...what an amazing experience to be able to say to other parents..."How many carbs do you think are in that?" How comforting to groan with another mom that the night might be rough with the likely highs from eating out. For the first time ever we forgot to bring insulin...how amazing to have another adult Type 1 bring us a bottle, and also a new pump site for Sean to try that she thinks he'll like better.

This morning new friends came down without the mom. "She's still sleeping?" I ask. "Rough blood sugar night" says the dad. Their adorable T1 daughter sits laughing and happy. How comforting to look at them and know exactly what it is like. The exhaustion, the worry, but the pure joy in seeing your happy child un-phased by the rough blood sugar night as they slept soundly while the parents kept watch.

The morning wrap up lecture was incredible. But, it was completely emotionally draining. There were many tears shed as one dad shared his experiences in raising two T1 kids. The fine balance between supporting your child, but yet allowing them to stand on their own. The inspiring slides of all the famous and not so famous type 1 kids that have grown up to do amazing, amazing things. The powerful words he spoke to all the T1 kids as he told them they can do "ANYTHING!"

There were tears shed by Jess when we told her it was time to go. She handed me a stack of papers with all her new friends phone numbers. I watched as they giggled and talked of meeting in Orlando this summer for the Children With Diabetes Friends For Life conference.

So many other huge things happened...we met Kerri Sparling of Six Until Me. My kids adored her, treated her like a celebrity, and asked for her autograph. For me, it was surreal...I have read her blog so much these last two years. Her musings have comforted me, brought me hope, and been refreshing in their honesty. To meet her in person, was truly incredible.

Watching Jessica be in the majority instead of the only kid with diabetes was phenomenal. Here, at this conference, Courtney and I were the minority with our still working pancreases. Yet we were welcomed as part of the Type 1 diabetes family. I watched thankfully as a T1 adult told Courtney that it was ok her pancreas still works, and explained to her that she was something called a T3 and that Type 3's are incredibly important people. I watched as Courtney became fast friends not only with all the type 1 kids but the siblings without diabetes as well.

As we have found with the other family support weekends we have attended...return to the real world is hard. At the conference the food is labeled, and the world is sheltering. We left so incredibly happy that we attended, but also emotionally drained. There is so much intellectual information to absorb, and so many emotions exposed that I find I come home exhausted. I find myself wishing that every one of my patients could find a support group such as Children With Diabetes. We all returned more motivated, and more healed. And, we are already counting down the days to our next Children With Diabetes conference.

The Good, The Bad, and The Ugly

Insight. I'm thankful for it, but it doesn't alone make what happened last night easy to bear. I didn't sleep well and woke thankful that I have a place to air the dirty laundry and hopefully in the process help others to not feel alone.

Jessica was exhausted. Second day back at school after a long, luxuriously unscheduled break. She had a babysitter all night due to really late work meetings for mom and dad. A social studies test tomorrow that she is stressed about. And, then for whatever reason her pump site that had apparently been bothering her all day started to really hurt. The debate...do we change it at 9:30 pm or not? And, as a side note...why in every rare while do these sites start to hurt after only being in a day or two? Scar tissue hitting a nerve??? Anyone know??? At any rate we make the possibly unwise decision to change it. Due to her once again somewhat high numbers I am unsure if it is working well, and figure the last thing we need on a busy school morning is an unexpected site change. Besides, I reason, we've gotten pretty good at quick site changes. We should be able to get a new one in lickity split and get her (and her sister) back to bed which is where they desperately need to be as it is now 9:45 at night. My T1 hubby says he'll do it (thank God) and I jump on the computer for my ever so disliked task of planning tomorrows meals and carbs.

And then I hear it....a blood curdling scream followed by hysterical crying. Apparently, we have hit a nerve. Now, I am sure it hurt. But, in my experience as a mom I have definitely learned that in a over-tired child crying breads more crying. And, in this case a complete breakdown. I know from common sense, and from the absolutely wonderful SETEBAID (we turn diabetes around!) family support weekends, that I need to let her have her emotions and just support her. But, this one was a doozy. She laid pounding her fists screaming "I want the artificial pancreas now." "No, I don't...I don't want anything, I just want a cure" followed by more sobbing and "I know a cure won't come in my lifetime....it is just too hard to do....I mean how will they get my broken pancreas out?" And then she turns to my husband "this is so much harder for me....I got it at seven....you didn't get it until you were seventeen....why did I get it so young???" This followed by even more self pity that as a parent was devastating to watch..."Why me???? Why did it have to be me????" At this point her twin sister who is there also holding her and telling her she loves her bursts out crying. Now, anyone at all insightful would realize that Courtney, being Jessica's twin sister, probably asks herself this on a routine basis. Courtney is now crying. "Jessie....I wish it was me. I wish I could give you my pancreas. I want it to be me." She then declares "Jessie-I know what I will do when I grow up...I am going to find a cure." At this point Sean and I are near tears ourselves. Well, that's a lie. I am in tears. A psychiatrist would just have so much fun analyzing this on so many levels.

We let them cry, telling them we love them. We stress to Jessica that she is not alone. She has so many who love her. I remind her of all those that support Team Jessica through walking with us and contributing. I know from medical school training that you never, ever take away a patient's hope. Sometimes that is all they have. I tell her that scientists are working hard everyday to make better technology and to find a cure. I tell her I know it will happen in her lifetime. I remind her that we don't know why things happen. I remind her of our adorable, beautiful friend who lost his little short life to cancer. It wasn't his fault, just as this isn't hers, just as all the incredibly crappy things that happen to so many are not their faults. I tell her I am sure she will do great, amazing things in life because diabetes has made her stronger. But, I tell her she has every right to feel this way...it is normal...anyone would. But, we will not let diabetes win. She hugs me tight for what seems like forever. As tears stream down my face I pray I am doing this right...being what she needs...saying the right thing. But, I also know there is no "right," and remind myself that 99% of the time she is a well functioning, happy, amazing child. And, I am so thankful she feels safe and can have these kind of breakdowns as I also know they are necessary.

I take Courtney aside. My heart aches for her as much as for Jessica. I tell her what an absolutely amazing sister and daughter she is. I tell her that it is ok she was not the one that got it. It is not her fault. It is nothing she did. None of us know why it was Jessica, but I would never, ever want Courtney to have it. I tell Courtney that she must follow her dreams. I tell her that the way to support Jessica is not to dedicate her life's work to finding a cure if it is not her passion, but to always support Jessica, which is exactly what she is doing. She, too, gives me a huge hug. And, I again try to remind myself that I have to believe she will be ok. And, I remind myself just as these events are Jessica's life story, they are also Courtney's. These events will shape both of them, help them to be resilient, and make them who they will become.

We finally get them to bed at 11 pm. I give my wonderful husband a huge hug. I tell him that as absolutely heart wrenching this evening was for me, I know it was worse for him. I remind him it is not his fault. Just shitty genes, and whatever environmental factor triggered them. I remind him what a wonderful role model he is for her. He doesn't say much...he is always the picture of quite strength. I can only imagine what is going through his mind. I tell him I love him and we will get through this together, just like we do everything.

I remind myself that things could be so much worse. Insulin exists. We can afford it. She doesn't have cancer. We have such great support from family and friends. I allow myself a few minutes of self pity in the shower. I feel alone. I am so tired of it. I'm tired of not being able to get her numbers under control as she seems to be hitting growth spurt after growth spurt. I'm tired of feeling it is my fault I can't. I know I am smart...shouldn't I be able to control these ridiculous numbers. I am tired of picturing her sticky red blood cells and worrying that they are already causing damage. I'm tired of worrying about the emotional impact this hated disease is having on my whole family. I'm tired of it taking so much of our strength, time, money.

But, I dry my tears, We will march on. We will not let diabetes win. I remind myself of all we are doing. I remind myself that life is full of ups and downs, but that it remains beautiful. I remind myself we are not alone. We have so many who love and support us, and for that I will always be incredibly thankful. I feel so thankful we have a Children with Diabetes weekend coming up in February. I will register for the next one in June. I feel thankful I realized this week that Jessica can take Courtney with her to Clara Barton camp. She has refused to go to camp as she doesn't want to go without her sister. Thank God Clara Barton has been wise enough to realize that siblings are a part of the team. I decide I will email her wonderful healthcare provider and ask for help instead of waiting until the next appointment. I remind myself that diabetes has made my family so much closer and made me a better doctor.

I remind myself that to fully enjoy and appreciate the good in life, we must deal with the bad and ugly too.

All I Want For Christmas Is A CURE!!!!

Merry Christmas and Happy Holidays to all the families, our kindred spirits, living with Type 1 diabetes.

It is a good time to reflect and give thanks.

I am so thankful for family and friends who support us.

As time goes on I realize how important it is to have people who knew us, and Jessica, "before." We are so thankful you have stood by us, and continue to love and support us.

But, I am also thankful to have met and become friends with those that met us "after," yet still accept us with all of our crazy nutrition label counting and crankiness after sleepless nights.

I am so incredibly thankful for Ellie, Jessica's health care provider. She is absolutely the best, and although it was quite a journey to find her, it was worth every step. Every family living with type 1 deserves someone just like her.

Thank you to the people and companies who have developed glucometers that give an answer in a few short seconds. I still hate the callouses on my daughter's fingers, and she hates how "long" it takes. But, we both know this technology has come so far.

Thank you to Animas. Yes, I am naming a brand! We love your pump, your customer service, and your colors! Thank you for realizing that water proof pumps and meter remotes are a super big deal to kiddos, and to their parents. And, thank you for replacing hers when it broke! We are especially grateful to your vacation loaner program as it saved us on a recent trip to Colorado when Jess's pump made a strange R2D2 sound and then shut off (such a good reminder to download your settings regularly!). And, please get your new pump/CGM from Europe over to the USA!

Thank you to the JDRF! You are such a worthy organization. You give us a cause. You provide us with hope. We know how lucky we are to have a disease for which there is such a powerful group advocating and dedicated to finding a cure. We have raised over $14,000 for the JDRF in two years and will continue to do our part!

Thank you to all of those who have contributed to Team Jessica. This has been such a huge source of support to us. We have been amazed and humbled by your generosity.

Thank you to fellow bloggers. You make us realize we are not alone in this journey. You are our kindred spirits and we learn so much from you.

Thank you to our health insurance company. We may have a huge deductible, and our health care bills take a large part of our income, but we have insulin, strips, and pumps, and access to health care. We never forget that so many can not say this.

Thank you to Banting, Best, Macleod and Collip--you saved my husband's life, and now my daughter's. We are forever thankful for your discovery of insulin. It may not be a cure, but there is no doubt it is life support.

Thank you to all the others I am forgetting, and I am sure there are many. We know how fortunate we are, and we appreciate it.

Wishing everyone a very Merry Christmas/Happy Holidays. And, how could I not end with one wish? A cure. Santa, all I want is a cure. I will patiently wait until you can put that in my stocking!

Teamwork

We've been incredibly lucky that for the first two years since diagnosis, Jessica has been shockingly compliant. I knew it would not always be so, although I hoped that it would. And, seriously...who really can be completely compliant when managing any medical condition? I've been in practice, and on this earth long enough to know compliance is really a myth. We can try our best to do "the right thing," but long term it is a hard reality. And, so most of us try to focus on "good enough." Diabetes is perhaps the ultimate compliance tester. Who can truly measure and count the carbs in every morsel of food they eat? I can speak from experience that "good enough" has to be the rule.

The problem is that lately I don't even think we are at good enough.

For the past month Jessica's numbers have been completely out of control. Her mood has matched her numbers, making it even harder to try to get things back on track. She's been irritable and frustrated. She has also entered the age of refusing to wear her dexcom (more sleepless nights for mom and dad), hating how her pump looks, and hating being different. More days than not when I pick her up she has had whatever random treat was brought into class that day, and either not bolused for it, or guessed at the carbs. There have also been a paucity of blood sugar checks. All of this has made it incredibly challenging to figure out what basal or I:C ratio needs to be adjusted. She is tired of being high and has repeatedly asked for her rates to be changed. I have felt like throwing my hands up in the air and screaming "Do you want me to randomly pick a rate to change???" In short, things have not been good, and we have not been on the same team.

I am so tired of the whole thing, and I can't imagine how she feels. It is such a relentless, exhausting disease. And, I have a hard time coming up with one that is as emotionally charged in the guilt factor. We eat fast food due to no time and I feel guilty. Jess has the class treat and I see her guilt when she tells me. I hate the ridiculously unhealthy relationship with food that diabetes fosters. Yes, she is overall eating healthier because of diabetes, but I hate that she feels guilty about having the treats all the other kids have. And, of course I am left wondering why the heck are our kids having so many treats???? But, I digress.

I have tried to talk with Jessica and it hasn't gone far. Tonight was different, although I am not altogether sure why. She checked her blood sugar and it was 298. For whatever reason, this time she started crying and said "I am so sick of being high." This led to a deluge of information from there. She hates diabetes (I knew that), the longer she has it, the more she is doubting a cure will come. She is tired of taking care of her diabetes and doesn't want to do it anymore, but yet knows she has to. She is reading a book in school where the character loses a toe, and has not been able to stop thinking about her losing her own toes. She's tired of being high. She's tired of feeling cranky. And, the list went on and on as I just sat and held her.

We've reached a road not yet traveled. My little girl that I can truly take care of is no where to be found. Instead there is this tween who is making her own decisions, yet obviously still needs my help. But, the help is different. She no longer wants me to write out her meal plan. She will no longer let me tell her what to eat. She wants to make her own decisions. And, that is completely reasonable. She's also scared, yet doesn't admit this to me like she used to. She thinks she now knows more about diabetes..."you have no idea what this is like..." and she is somewhat right. She does know more about some aspects. I will never truly understand what it is like to be the person living with this. For as completely exhausted as I am (I swear I have aged ten years in the two since she has been diagnosed), I can not imagine how exhausted she is.

Tonight I realized that although I have always tried to let her take ownership, and have tried hard to teach her instead of telling her, I need to do more. She's great at reading nutrition labels, but when a cake or brownie comes into the classroom this doesn't help her. So, we got back out the carb food flashcards we haven't done together in over a year. We went through them together and both guessed and made it a game to see who was right. She asked if we could do it again soon. I told her about an online carb counting class she could take, and she was thrilled. She wants to learn more, and I know that knowledge will only help. We haven't focused lately on keeping her diabetes education growing, and I realized tonight that we need to do that now.

I know the seas won't be smooth sailing, but for the first time in awhile I felt like we were a team again tonight.