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Helping Young T1Ds with School Mornings

As a new mom living with T1D, I admit I was a bit over-reactive. Let’s just be blunt- I was nuts! The hormones took years to settle after my daughter’s birth. No yoga class for me the next week! I was paranoid that I wouldn’t be around and in a healthy state to help raise and guide this new baby I had brought into the world. So I set about making sure she could take care of herself and I did it FAST! As I spend more time helping families juggle the world of diabetes in young children, I realize that many of the habits I set for my non D child, are beneficial for young families managing young T1D school mornings for many of the same reasons: managing morning stress, building self-esteem, building a sense of control, and practicing a set of healthy habits for a lifetime.

My mom started these for me in the late 70’s. This was pre diagnosis, but it helped me to be ahead of the curve and capable of taking care of my T1 life when it came rearing its ugly head. She wrote out on index cards and placed in my bathroom, a list of things to do each morning and each night on my own. We laugh now as I struggled for several years to comprehend (put on deo). It was for my older sister, but I really didn’t have a clue what deodorant was, much less deo. The index cards got wet over time so I recommend a good laminator!

I put a similar set for my toddler on two hanging hooks in her room. These were laminated picture cards with the words (teaching that reading early). They had images of clothing, brushing teeth, brushing hair, eating breakfast, making beds, putting on coats, getting a backpack ready, etc. There were a few blank ones that you could add your own (perfect for a T1D lifestyle). I hung all the cards on one hook in the order I wanted it done. We ended up changing this over time due to her preference. Once she had completed the task; she flipped the card to the empty hook. By the time we were ready to walk out the door, all the cards should have been moved to the new hook.

When living with T1D, it empowers children to think they have some control over this hectic lifestyle. Give them the chance to see if their pumps or devices need charging, is their diabetes kit filled with supplies or are they low on test strips or glucose tablets that day? It helps to make sure they even remember putting their kit in their backpack. Do they have their portable chargers for their phones or CGM devices? Admittedly, parents will need to check the list for accuracy, but it is never to late to let them start. One day it may surprise you that the stress of micro-managing a child with T1, eases with the mundane tasks because they have learned it on their own. There is also a benefit to not having to “discuss diabetes” and use the visual reminders. Most of us are tired of feeling like T1D consumes our entire day, so a visual reminder from a parent might help the rest of the daily audible communication.

I also am a firm believer in no TV in the morning. This is a personal choice, but I stand by it. It is much harder to drag a child to get ready for school if something animated has captured their attention. I also disagree with TV on the ride to school. Remember I was a bit crazed in this stage, so talking, singing, and communicating with my child was my priority. Thoughts of the moment, what we saw out of the window, feelings, excitement for the day, how she felt, etc., ruled our rides to school. For young T1D kids it is equally important. This can become an established safe and short talk time. Most days hopefully it will be about normal toddler or child talk. Laughter and excitement are the goal. Other times it could be the gateway to learning if anything is bothering them at school due to diabetes. Is there any bullying going on or alternatively has a friend been extra supportive? Is the nurse’s office a good vibe or does the child want to begin to take more independent steps?

My goal was to never have her leave me in the morning upset or me angry with the morning schedule. This wasn’t perfect, but due to the ease of our morning schedule, we had extra time. We had time to talk down the fears, time to talk through the obstacle of the day, time to deal with a forgotten item. We had time to park instead of run through the drop off lane if we needed to gather reinforcement for the day.

It doesn’t run like clockwork always. I have been the working mom and the stay at home mom. Both present the challenges that seem impossible to overcome. Being a mom with T1 is not that much easier than being the kid. We all need to build and continually reinforce that feeling of control. We need to take the time to prioritize the hours of the day to go out into the world prepared. We all have unexpected lows or high surges and slug through the morning routine feeling heavy or weak depending on BG levels. Having that routine set at an early age has saved me during the hard mornings. Some tasks are simply ingrained in my head.

I have had days that we arrived late, not because of my child, but me. I have had to pull over and sit out a low during driving. I have had to turn around for a forgotten item. However, those moments were few and yelling to get teeth brushed was never an issue!! I wish all families and kids extra support during these back to school times. If any of these tips can be used or modified to fit your routine with a young T1D kid, I hope it can be an inspiration.

Happy school mornings to all of you! Marianne

Anxious but still calm on school days
She had a wonderful Pre K experience with an amazing teacher
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Type 1 Diabetes 504 Plan Help at School

I love helping families manage the 504 process. Sometimes, I just provide information and other times I go to bat for your kid during the meeting. Occasionally, just a little distance from the immediate emotions can make a meeting more manageable and productive. Check out the American Diabetes Association’s information for more help. Happy back to school!

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Travelling Tips

Hitting the road:
Travel tips for life with diabetes.

I love to hit the road! Last summer I took my daughter, her friend, and my dog, on a 16 day cross country road trip east to see some of Americana that we miss out on living in the west. We went through 12 states and did most of the touristy stuff along the way! Sound crazy? Yes, it was, but I loved it! This summer takes me on several out of state adventures both to the east coast and west coast with a few stops in the middle. I am eagerly anticipating each one. How do I manage to keep control on my life with diabetes while traveling? Again, like most things we do, it simply takes some extra planning!
A few necessities:
• Take a travel letter with you from your endocrinologist or family doctor. This letter states what conditions you have and why you need to carry these medical supplies. I have NEVER had to use one in over 33 years, but I always take one in my carry on.
• Take extra supplies. If flying pack 2x what you need in a carry on and the rest in your luggage. This only applies to supplies not temperature sensitive.
• For temperature sensitive medications I like to use the Frio cooler pack. If flying, keep in mind TSA screenings, air pressure and underneath cargo temperatures. If driving in the car, keep a small cooler to protect medications from the heat when stopping for periods where the car will be heating up while you are enjoying the sights or a roadside meal. Remember to not put your insulin directly near the ice. Wrap it in a cloth and then keep it in a Ziploc bag to prevent it from getting wet or too cold.
• If you are traveling to a foreign country, look up the words associated with diabetes. Learn the name of your medications in the native language. Also look up where the nearest pharmacy or hospital are near your hotel or where you will be spending most of your time.
• Double check your phone plan accessibility for travel charges and if there are any specials things to consider.
• Know that you can change your local times on your pump and your meters. To be honest, I rarely do this, but for some people with diabetes, it would be a necessity
• Wear your diabetes identification. No exceptions. Make sure someone traveling with you knows where your supplies are and what to do in case of an emergency.
• Ask hotels for the use of a mini fridge. Sometimes I do this and other times I don’t. It depends on how long I will be staying in one hotel.
• Keep snacks in your carry on or in the car. For road trips I love to save up gift cards for fun stops along the way. In my everyday life I might reach for a GU chew or a glucose tab, but on a trip I might splurge on a carb laden drink from Starbucks! Caffeine and sugar high to keep on driving.
• Bring Sunblock and insect repellent. Sunburns can impact our BG control and make it very uncomfortable to change pump sites or CGM sites. Bug bites can lead to the same thing. Be sure to check the expiration dates on these as they can get old or be less effective if out in the heat by the pool for extended times.
So, hit the road or the air and enjoy this summer of travel. A little extra preparation can make your entire diabetes life much easier while traveling!

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Summer Tips

I don’t think I am a typical parent! I start getting excited for this time of year. I love the fact that my kid is getting out of school. I don’t dread this time, instead I get a lighthearted feeling when summer arrives. Perhaps it stems from the monotonous routine of daily diabetes care that we all must endure. Don’t get me wrong, I am not suggesting that we all forget the rules and neglect our health. I rather suggest that we take this time to ease our schedule and loosen the leash on the diabetes hold. It is time to take some steps to reframe your life with diabetes.
Loosening the reins on diabetes management can happen whatever your summer plans entail. If you are in the workplace with no summer vacation plans or if you are trying to manage a houseful of kids and summer activities, or travel, you can reframe diabetes. The idea is to reframe your mindset. Don’t toss the rules to the side but use these days to reframe how you think and plan to approach the autumn season with your healthcare. This can be done in a series of steps. Some people with diabetes might need to use all the steps or perhaps just focus on 1 to achieve a better healthcare approach in the fall. Bring on the dog days of summer!

1. Stress management
I think this is one of the most overlooked aspects of our diabetes healthcare. Try to develop a habit of better sleep. The favorite TV series have finished for the season. Try to tackle sleep an hour earlier with a cool down period for 30 minutes even before that process starts. We have all heard it before, but during these summer months, take it to heart.
• No electronics (other than the insulin pumps and CGMs of course), so turn off the tv’s and put away the laptops and phones with any social media or news feeds.
• Practice having your low Blood Glucose (BG) supplies at the ready. Have water by the bed.
• In the 30 minute cool down mode, check your insulin pump reservoir levels, battery levels, etc. I hate climbing into bed exhausted and realizing that I only have 5 units left in my pump and I need to plug in or change batteries. Take the summer months to establish this pre-sleep routine and you will be amazed at how it translates into a lifestyle change.

2. Exercise/Stretching
Most articles about summer focus on upping your level of exercise for better BG control. I agree with this theory, but not for the sake of this article. I want you to focus on stretching your bodies this summer. The wonderful part of this practice is that it usually doesn’t send your BG level crashing; it calms, strengthens, and relaxes the body.
• When you get out of bed, whether rushing off to work or sleeping in for the lazy days of summer, stretch while you are still on your mattress. Lengthen your body and point/flex as much as you can before you even lift your head. Then from a sitting position, straighten your spine, circle your neck and stretch your arms. Open and close your fists. Get that blood flowing.
• If you already have a regular exercise routine that is great, add this anyway. It is about helping your body, but it is more about creating a mind- body connection. Take the few minutes during the stretch practice to be thankful for your body, even if it is more beat up than you want to admit. You still have it and have been given this day. So stretch, feel the strength in your muscles, recognize the pain if it exists and do not curse it, but make a note of what needs extra TLC that day. Stretch those parts that are a little stiff, sore, or tight.
• Carve out time for at least three more stretching sessions in your day. Sitting at a desk, at lunch, coming home, being with your other family members (spouses and children can participate) and especially before you start the 30 min cool down at night.

3. Use the extra time to plan
Let’s face it; this is something that we can’t escape from in this life with diabetes. We can do anything we want – IF WE PLAN FOR IT! If you are taking a break from the morning school rush, use this extra time to better prepare for your day with diabetes. It doesn’t matter if it is for yourself or your kids. You have some extra time. Slow down and help yourself to get a grip on the normally overwhelming mess of life with diabetes.
• Take the time in the morning to look at your bag of supplies. Is it missing anything? Is it getting low on test strips, glucose tablets, or alcohol swabs?
• Add things to the grocery list and take the time to pack extra snacks for the office or the summer activities.

4. Ask for help
This is not a sign of weakness and we know that you can do it when you have to by yourself. This is not one of those times. Get your kids on board. Get your spouse on board. Get a friend on board. Most of us struggle with trying to make the impression that we can handle it all. Our kids, if they live with diabetes, need to realize that they too will need to learn to carve out time in their daily lives to regroup just as much as an adult. Not only is it necessary, but it is healthy. We will run out of steam rushing to keep up with the regular schedule all by ourselves. Take the summer to find the courage to ask for help. Help your family work together as a team to support the person with diabetes by all helping manage food, supplies, and by simply remembering to take the time to stop and reframe your day.

5. Change up your routine and have some fun
If you are taking a vacation, spending time with friends or family or staying put, try to incorporate some fun into your life. We have enough pressure. We have enough responsibilities, we have enough stress. Let go of the guilt of doing everything. Let the dishes go. (Well, I don’t do this with ease), but I do like to throw in an extra nap here and there. I am tired of hearing the same old stuff on the news each day, so in the summer I turn to reading. I feel guilty, like I should be working more. I now know that it is important to expand my mind and find some enjoyment. I reframe.

6. Give up the guilt
This is my number one proactive tip and the one I struggle with the most often! If you live with diabetes you know that with almost every aspect of our life comes a tidal wave of guilt. This guilt revolves around maintaining BG levels, sticking to our meal plan, exercising, and balancing our emotional well-being with our daily life. I feel judged in every aspect of my life, whether I truly am or not. I feel judged when I am seen eating, I feel judged about my weight. I feel judged about how much I exercise. I feel judged about how and when I correct for high and low BG levels. I feel judged by how stinking expensive I am (and I am not even talking about buying shoes or clothes)! I feel judged about leaving the house without all of my supplies, when I should order my supplies, and keeping on track with scheduling all of my various doctor appointments. It is overwhelming and once I get a grip on one, it starts all over again. There is no finish line or final touch point for me to stop trying harder. Take these summer months to try to let go of the guilt. If you are the managing D-momma, let go of the guilt of what you are managing and reframe your thoughts about how you are handling things. Give your kid a break on the lectures this summer. Focus on a team approach instead of the individual approach. Guilt doesn’t motivate many of us to be better– we just keep trying with a heavier load to carry and a sense of loss and frustration. Spend this time forgiving yourself and your defective pancreas.