Wednesday, October 16, 2019

In Which Diabetes and ADHD Wage War Within My Brain

There's Mom Brain. There's ADHD Brain. There's Diabetes Brain. Then there's my experience: Mom with ADHD Managing Her Kid's Diabetes Brain. Trust me, this one is very bad. As much as I try not to let our challenges control our lives, sometimes the whirlwind of them interacting with each other does, in fact, overwhelm me.

As I've mentioned before, I don't have an official clinical diagnosis of ADHD. It's unlikely I'll ever pursue one, because I don't see a practical reason for me to have the documentation, but the more I've learned about ADHD the more I'm certain that it explains quite a few things in my life.

Over the years I developed quite a few strategies to help with the fact that I had a hard time remembering details and was always losing stuff. When I was in high school and old enough to drive myself, I forgot to bring my lunch with me a few times. I solved that problem by taping a note to my steering wheel that read, "Remember your lunch." I repeated the practice again in grad school when I again found myself frequently forgetting my lunch and my roommate (who was working a second shift job at the time) got tired of bringing it to me :).

As long as I stuck with my routines, I usually managed to do everything I had to do. I struggled for a bit to adjust after Squirrelboy was born and as he entered each new stage and new things were added to my plate, but I was always able to establish new routines that kept me on track most of the time.

Things did get more complicated when I added a second child. I started to forget irregular events on the calendar like doctor and dentist appointments. I made a habit of writing absolutely everything down on the calendar in the kitchen and looking at it every morning, which mostly solved this problem.

When I started forgetting where I put my keys even when I had an established spot for them, I started keeping them in my vehicle when it was inside the locked garage and in my purse when it wasn't. By the time Kittygirl was in kindergarten things were going really well. I'd added the complication of homeschooling Squirrelboy, but I had a schedule established and it was going well. Then, just over halfway through kindergarten, Kittygirl was diagnosed with type 1 diabetes.

There are a lot of things to hate about T1D, but the thing that is hardest for me is the details. ALL.THE.LITTLE.DETAILS. There are carb ratios, there are correction factors, there are carb counts, there are low treatments, there are prescriptions to refill every single month. Sometimes I would bolus Kittygirl for a certain number of carbs and then forget to give her some or all of those carbs. The worst case was when I bolused her for a snack she was going to eat on the way to the park with Mr. Engineer and then completely forgot to send said snack to the park with them. Her blood sugar dropped to 25. Anything below 70 is considered low.

I'm incredibly thankful for Kittygirl's insulin pump and continuous glucose monitor, but that technology adds an additional layer of things to remember. First every seven and now every ten days we need to change the Dexcom sensor. Thankfully the Dexcom app reminds us so it's hard to forget, but it is still possible to dismiss the reminders and promptly forget about them during your busy day. The pump doesn't remind us that the site needs to be changed every three days, so I've forgotten until the morning after it should have been changed. The clue has usually been that her blood sugars were on the high side because the site was losing its effectiveness.

After managing Kittygirl's diabetes for 32 months now, we've reached a pretty good understanding of how different foods act in her body and how we need to bolus them. In the case of toast, which, at least for her, digests slowly, I need to do an extended bolus with the pump, giving 50% of the insulin shortly after she finishes the toast and 50% slowly over 2 hours. Sometimes I have to wait a little bit after she eats if her blood sugar is trending down on her CGM graph. Most mornings Kittygirl eats fruit, 2 pieces of toast, and 2 sausages. Our goal is to keep her blood sugar within the grey range on her Dexcom graph, which is between 80 and 160. If all goes well it looks like this:

On Sunday, all did not go well. We had friends staying with us for the weekend, who were making their own breakfast in the kitchen while Kittygirl was eating her breakfast. I had to help them find what they needed. I also wanted to make sure I said goodbye to them and that they didn't forget anything as they packed. I had to eat my  own breakfast and make sure Kittygirl was dressed in time to leave for church at 9:15. Then our children's pastor texted me to ask if I could step in to work at the preschool check in desk because someone was sick. That pushed our leaving time five minutes earlier. Amidst all these changes, the fact that I hadn't bolused Kittygirl's toast yet left my mind. When I was helping her get dressed, the high alarm on Dexcom went off, which means her blood sugar had reached 160. However, I didn't start a bolus right away because I was changing her her pump pouch and arguing with her over the fact that she had to wear one that held her phone as well. Then I looked at my watch and realized we should already have left for church and, yet again, the fact that I hadn't bolused for the toast went right out of my head. I finally remembered when I got to church and Kittygirl's blood sugar was already in the 200's. This was the result:

The gap, by the way, is from some time when the signal wasn't transmitting. The different timing made all the difference to keeping her blood sugar in range, or her blood sugar going way out of range.

After this experience, Mr. Engineer suggested that I set an alarm on my phone to remember to bolus the toast. That's what we've done this school year for Squirrelboy to remember to take his ADHD meds before leaving for school. When he was homeschooled, I could just have him take it when I realized within half an hour of starting work that he'd forgotten, but, if he forgets at school he just has a bad school day.

I may initiate something like this, but it still might not help in a situation like Sunday's because I would have to remember to set an alarm amidst all the chaos distracting my brain. I've forgotten on school days as well, though, so a regular weekday alarm could be helpful. I do tend to be resistant to ideas offered by someone like Mr. Engineer who doesn't often forget things, but I should probably get over that.

As the months managing my daughter's diabetes have stretched into years, I'm no longer normally overwhelmed by all the tiny details. However, they definitely add an extra layer of stress in holding things together and I still, 32 months in, haven't reached the balance I had before I introduced diabetes details to my brain and they started fighting with ADHD.

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