“Kisses for Cash” Kali’s Story T1D meets T2D

Picture1This third chapter book in the series introduces new characters in Kali’s life.  She is now eleven and a half years old, having lived with diabetes since she was two years old, and continues to care for her diabetic dog, Money.

Her Grandmother, recently diagnosed with T2D (Type Two Diabetes) comes to live with the family; Grandma decides to adopt a dog of her own in order to get exercise to help her control her disease as she is unable to handle Money’s girth; a new school friend, Tavius, is introduced while her bff (best friend forever), Wayne, pursues other interests.

Mishaps continue as well as young adventures that lead to learning experiences for all young diabetic boys and girls.

Suitable for all ages, this illustrated chapter book, consisting of 121 pages, is an easy acquaintance to learning about T1D.  I am sure you will enjoy it along with the two other books in this series as they were absolutely delightful to write.  Please let me know your thoughts!  Thank you…A. K. Buckroth (#buckroth, www.mydiabeticsoul.com).

Available at Amazon.com, Goodreads, Smashwords, and local libraries, and book stores.  Happy reading!

Here’s an excerpt beginning with Chapter 9….

Sitting at the kitchen table, staring at the brown cardboard box that was delivered a couple hours ago, I knew what awaited me inside of it—a new insulin pump. Mixed emotions surrounded me.  Sure, I was glad it arrived.  After all, it helps me stay alive, stay well.  I’m just a little nervous having to put it all together correctly.  It’s been more than two years since Nurse Nina first taught my parents and me about the insulin pump, and when I first began using one.  Slowly, I recalled all the details.

Mom and Grandma continued to tour the house, getting Grandma settled a little bit. While they were busy doing that, I got busy opening the eagerly awaiting box. I can do this.  For one, I’d be able to stop taking four injections every day.  Four and a half days of doing that was enough as far as I was concerned.  Second, the pump would give my body get the constant infusion of insulin it needs, an automatic squirt every three minutes.  I don’t necessarily want to do this. I have to!

It was really nice walking around without it. Different.  I felt free, really, not having it clipped to my pants, not having to worry about banging it, dropping it, or getting the tubing stuck on a doorknob or pants zipper or something.  But the alternative was bothersome—pausing to get my insulin pack, filling up a syringe, sticking it

somewhere in my body, being careful to remember not to use the same area twice, etc, etc. So many details to remember and plan.  Plan, plan, plan.  That’s a big—no, huge—part of my every day!  Oh well.

Opening the box with a pair of scissors while it rested on the kitchen table, I sat, getting real serious about this process. I concentrated.  There was a little white cardboard box inside the bigger brown one surrounded by lots of plastic bubble wrap and more clear packing tape.  Protection.  Geez, what I call a ‘paper trail.’  It takes a while to get through all this paper.  I’ve often wondered if this company knows about recycling.  Geesh.  Once opened, the new pump gleamed in all it shiny newness.  Clear in color, its five command and use buttons were displayed in black bold letters on the front, under the LCD screen.  I could see right through it.  Such a little thing, it weighs only 3.5 ounces, so I was told.  In fact, when some people have seen it attached to my clothing, they’ll ask me “why do you wear a pager?” because it looks like a pager.  I answer “It’s not a pager.  It’s an insulin pump.”  Then I get all kinds of reactions: either they shut up right away, seemingly shocked, not knowing anything about such a device.  Or, they get real interested, asking questions of interest with a short conversation.

Set aside are supplies that I already had: an alcohol swab, a vial of Apidra insulin, a 6 millimeter 23 inch infusion set, a reservoir, a AAA battery, and a dime. As I was taught to do, I let the Apidra insulin vial sit out for an hour to become room temperature-ized.  I have always used a dime to open the slim battery case.  Sure, there’s a ‘plastic unscrew battery thingy,’ but I didn’t know where it was.  The dime fit just fine to unscrew the top of the battery case area and insert a new battery.  With that done the pump’s LCD (Liquid Crystal Display) screen lit up and blinked on as if happily awakened.

When I pressed the familiar “ACT button,” it displayed various commands, choices of what I wanted or needed to do with it. Pressing the down arrow button, I chose “Time and Date” and pressed the month, the day, and the year.  Onto the time of day, I pressed the up and down arrow buttons a few times.  The time of day is important for the pump to squirt—release—the hourly programmed dosage of insulin.  For instance, between midnight and 4am, it was programmed at the time to give me .4 (four tenths) of a unit as opposed to other day time hours when it gives me .6 (six tenths of a unit).

Next, I gently peeled open a small square reservoir package. This light-weight object arrived in a carton of ten.  They looked like small syringes, each with a light blue needle head attached.  These hold the insulin inside my pump.  Pressing its clear plastic lever back and forth a few times made sure it slid easily in order to move inside the pump.  Just a precaution, I guess.  It’d be in the pump for about seven days.  I made sure it would slide easily to disperse insulin for all that time.

I heard my parents and grandmother enter the kitchen. They were watching me.  All was quiet.  I smiled.

“You guys don’t hafta be so quiet,” I said.

“Well, you look like you’re concentrating so hard, so serious. We didn’t want to bother you,” my mother remarked.

“Can I sit and watch you, Kali? I’ve never seen such a thing,” said Grandma.

“Sure, sure,” I told her. “It’s almost ready to insert into my leg.”

Grandma looked like—well I don’t know how to describe it. She looked like she was going to cry with her blue eyes wide open and her eyebrows crinkling on top of her forehead.  With the attached needle head, I pressed it on to the insulin vial, inserted air into the vial, then withdrew it slowly, pulling on the syringe stick lever to fill it up with insulin.  The maximum units the reservoir tube holds is 180.  If there’s a problem, the pump will beeeep non-stop until I give it the attention it needs.

For instance, Dr. Ansari, my endocrinologist, calculated that a warning, a loud beep, would sound when there are 20 units of insulin left. If I were to hear it, I would have to look at the LCD screen to see what the pump is telling me first of all.  Then I would shut it off by pressing the “ESC”—Escape— button.  Ha, I’d like to press a button to escape sometimes, haha.  A couple times it beeped non-stop with the screen blinking in upper case letters OCCLUSION! OCCLUSION!  OCCLUSION!  Just like that.  Non-stop.  That sound had woken me up a few times.  It’s an alarm.  Not good.  I don’t like insulin pump alarms.  This means that the tubing from the pump to my body is blocked and needs to be changed.  That’s the only way to fix the situation, to make the beeping stop.  Doing that at 3:00 in the morning is horrible.  It was Money that actually woke me up one time, pushing me with his nose.  The pump’s alarm sound woke him first.

There were other times, too. I’ve been embarrassed when in the mall or in school or out somewhere.  I had to immediately stop what I was doing and give my attention to the screaming pump that was clipped to my waistband.  I hate that!  People around me don’t know what the heck is going on and look at me like I’m weird.  Ugh.  They just don’t know.  Scurrying quickly to the nearest restroom, I’ve had to partially undress, shut off the thing, scrounge in my pack for an extra infusion set or whatever is needed, and change it, fix it.  Lots of crazy things have happened while wearing and carrying this thing when I least expected them too.  And lots of times I have been unprepared.

Like one time, I was in church with my folks and the pump started beeping—non-stop! OMG!  Talk about embarrassing!  I couldn’t shut it off.  My mother couldn’t shut it off.  EVERYBODY could hear it, I swear. We all scooted out of the pew to the restroom.  FINALLY quieting it down, I saw it needed a battery.  None of us had a battery.  So, we left service, had to go home, and get a stupid battery.  Ugh.  Sure, there’s a picture of a battery on the LCD screen – if I looked at it, I would’ve known that it was low! But I didn’t.  Ugh.  My fault for sure.  I know better now, another part of planning and preparing.

Next, on to peeling open an infusion set, I first calibrated the pump machine, setting my hourly, 24/7 (24 hours a day for 7 days), basal rate. I call that my “squirt rate.”

My mother pretended not to watch me and remained quiet. She kept walking back and forth from the stove, to the sink, to the table, occasionally breathing on top of my head.   I wished she would go into the other room!

Finally, the pump was all suited up. Oops, I almost forgot to attach the clip.  With that done, I re-thought hard about where the infusion set would go in and on my body.  My choices are certain skin areas on either side of my lower belly, two inches away from my belly button; the top, inside, or back of each thigh; either hip, as far as I could reach, or either buttock, as far as I could reach, and the lower, fatty areas of my upper arms.

With Grandma watching me too, I decided to put the infusion set it in my upper thigh. That’s the best place to show—demonstrate to her or anyone—how this is done without having to undress.  She got real quiet as I did this.  Tearing open a small square envelope with one alcohol swab in it, I wiped the area, making sure it was clean, sterile, free of germs.  Next, I opened the sterile packaging that holds the infusion set, removed the sticky paper on the round adhesive tape area that holds it to my skin, then I removed the bright blue plastic covering on top of the metal needle.

The insertion of the needle is like an intravenous needle, but the metal part doesn’t stay in my skin. It’s also called “subcu – subcu – subcutane – sub-cu-tan-e-ous,” phew, which means it doesn’t go into a vein.  I held my breath, gritted my teeth, and quickly push the needle into my thigh skin.  Phew.  Deep breath.  I don’t like doing this.  It hurts worse in some spots than others sometimes, not always.  I don’t know why.  Grandma looked like she was going to cry, especially when I pulled the needle out and rested it on the table to be discarded.  She stared at it, gasped, and stayed real quiet.

I often get little black and blues from putting the needle in or taking it out. That’s the way it is.   Like the little black and blues on my finger tips from testing my blood, I know why those happen – from doing the same fingers spots over and over.

Once the ugly and scary looking metal needle head is pulled out, a plastic infusion set stays in my skin attached to a flat, clear plastic head about the size of a quarter. That rests on top of my skin.  The tiny plastic needle-like tube inside my skin is about a quarter of an inch long.  Once that is done, I cover the head of it with a thin, clear, 2 x 3 inch sticky paper to keep it in place, to protect it and myself so it won’t come out.  It’s thinner than a bandage, comparable to a layer of human skin.  All this has to be done the day after tomorrow, again, but in a different body spot.

“Okay, Mom. I’m all hitched up.”

“Good, sweetie. Did you set your hourly basal rate the same way? “

“Yep. See?”  I showed her.  She gently took the pump in hand to review everything I just did.  As the tubing is 23 inches long, gently is a key word.  Neither one of us could move too far.

“Looks good. Good job.  Now test your blood, count dinner carbs, and take care of Money.  I love you, Kali.  Supper will be ready in about 20 minutes.”  Mom squeezed me tight, as always.

“Kali, you are so brave,” my grandmother told me. She had a tear in the outside corner of her eyes like they were going to pool up and roll down her cheeks.  Wiping her eyes with her thumbs, she stated, “I’m glad I was able to see you do this.  Now I know more about this pump and how you have to wear it and what you have to do.  If it’s all right with you, I’d like to see you do it again when you’re ready.  Watching you will teach me.”

“Okay, Grandma. I’ll let you know.  I have to do it again in three days.  Every three, or sometimes four days, I refill it and do this all over again, put it in a different body spot.  Rotate.”   I remembered that my last shot with Nurse Mickey was in my “Izzy arm,” the left one.  I call it that due to what happened last year when “Izzy the Infuriator” slammed me into the lockers.  Three days from now, I’ll put a new one in my upper left thigh or maybe my upper left hip.  We’ll see.  I go through the same process all over again, the same decisions, the same planning.

Sometimes I forget to tell my parents when my supplies get low. A couple times the pump company had to send them to me by overnight mail.  I’m supposed to notify them – my parents, really – when I have ten infusion sets and ten reservoirs left.  Then either my Mom or my Dad will call the company and place an order.  Usually it’s Mom.

A lot of my decisions of where to put the infusion set depend on the clothes I wear. I prefer pockets in all my clothes, front or back.  Skirts my size are more difficult to find with side pockets.  My once favorite faded blue jeans skirt had front and back pockets. The front pockets were big enough to hold the pump comfortably and securely.

Dresses? Forget it.  I’ve never had a dress with a pocket on it.  They just don’t exist.  When I do have to wear a dress, like the special one Grandma got me for Christmas, I clipped the pump underneath onto the waistband of my underwear.  But doing this makes it more difficult for me to access the pump when I need it.  And after a while, my underwear waist bands unravel and get worn out from the pump clip.  Oh well.  Once diabetes is cured, I won’t have to do this anymore.  I think about a cure for this disease every time I go through this.  I’d like to be cured—along with the rest of the world!  Ah well.  As my mother has often told me, “hope springs eternal.”

I don’t cry any more when I do this. Actually, either of my parents used to do it for me.  That was more than two years ago, when I first started using an insulin pump.  I used to cry.  But I know how to do this by myself and I understand why.  I still don’t like it.  Am I supposed to like it?  Nah.  I use it to stay alive.

Phew. That’s overonce again.

10.

All the insulin pump preparations with supply set-up, putting in a new battery, re-setting the hourly bolus rates, resetting the timer and date, filling the reservoir with insulin, making sure there are no air bubbles, letting it re-wind, putting it in the pump, attaching the infusion set tubing to my body, replacing the clip, and finally putting it in my body took me about twenty minutes.  A long twenty minutes!

Phew!

Re-setting this machine is what took me so long. Otherwise I would’ve had it in my body after only ten minutes.  What takes the longest is letting the insulin sit out to get  room temperature-ized.  That takes about 20 minutes.  My Mom did that while I was at Wayne’s.  She’s a great planner too.

Back on schedule, I feed Money —before I eat.

Chores? Like sweeping the floor?  Not yet.  I planned to do that after supper, when I clear the dishes and put them in the dishwasher.

I spent my after school “chore time” at Wayne’s house. That’s okay.  It was worth it.  I felt good about that but not a hundred percent good.  No homework to do seeing as it was almost the last day of school.  Heck, there’s lots of other stuff I could do!

“Kali, when is your last day of school?” Grandma asked.

“June 4th,” I declared with glee.

“And then you’ll be a fifth grader? Is that right?”

“A sixth grader, Grandma, I’m going into the sixth grade. “And summer camp starts July 5th,” I told her.  I couldn’t wait!  “Now that you’re here, Grandma, you’ll be able to come with us to drop me off and see the camp.  It’s really nice.  I like it—a lot!  Especially the big field where we play volley ball.  And the pond is right behind there with a dock and the canoes and row boats,” I excitedly explained.  “The cabins are in a half-circle around the pond with the fire pit at the far end.  I’ll show you.  We can walk around the who-oo-le place!  I can’t wait to see some of my friends, too.  Maxine, Lisa, Judy, Cathy.  Especially Cathy.  She wasn’t on a pump last time.  I tried to talk her into it.  Maybe she has one now.  I don’t know.”


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