Today is Type 1 Diabetes Awareness Day. The Raise Your Voice campaign was organized by Kerri of Six Until Me, who is one of my favorite diabetes bloggers. I hope that in twenty years or so, when Penny is about Kerri's age, there will be a cure for diabetes, or at least an artificial pancreas -- but if there isn't, then I hope that she'll be very much like Kerri, a beautiful woman with supportive friends and family, a wonderful fiancé, a fantastic sense of humor, a satisfying career, and the optimistic and upbeat outlook necessary to make allowances for her diabetes without letting it define her.

I know y'all have been following along with me on this since the beginning of February, but I want to take this opportunity to declare myself part of this community (albeit peripherally, as a parent and caregiver). I thought, for my contribution to the day, that I'd offer up a photo tour, but then when I started to take the pictures and write the the explanations, it got so long I decided that I would run this as a series, all week. (It works out well for me, actually, because I'm in training at work all week anyway, and won't have time to write my usual entries. Sometimes I cheat like that.)

So today's entry, to kick it all off: Watch It!

The key to successful diabetes management, as I read over and over and over again, is constant monitoring.

The first thing we have to monitor is Penny's blood sugar levels.

This is Penny's glucose meter and its associated stuff. It's not a special device for kids, despite the smiley faces. The smiley faces are a sticker. There's about five more designs of sticker tucked in the bag, should she change her mind. (She has two of these meters, actually. The other one has a sticker with little pink flowers on it.)

That's about a day's worth of strips -- we routinely check her sugars before each meal and between 10 and 11pm, before we go to bed. She doesn't even wake up for that check, anymore. We also check her if she's acting odd or if she complains that she feels low. If her night reading is off, we set an alarm and check her at about 3am. (Also, if Alex wakes up during the night, we usually do a check on her while we're up anyway.) She does wake up if we check her after about 2am, but she goes back to sleep pretty quickly. If we don't check her in the middle of the night, we'll usually check her first thing in the morning.

The long narrow tube is the lancet. I've used it on myself a couple of times, and it's much less painful than the usual finger-prick device that they use at the doctor's office. Probably because the ones at the doctor's office don't have an adjustable depth, and therefore are built to get through even moderately thick skin, which is way deeper than even my skin needs. Penny's lancet is adjustable on a scale from one-half to six, and we keep hers on 2. (In the beginning, we managed successful draws at lower settings, but it was sporadic. The 2 setting works almost all the time.)

It's got a little drum of six lances under its cap, and a trigger system that took me a bit to figure out when we first got it, but now I can operate the thing in my sleep. The fact that it holds six lances at a time means that we only have to change it about every two days, which is nice. (We have two of them, remember.) Sometimes the lancets get re-used, because Penny rushes ahead of me to set the trigger, but she always forgets to rotate the drum first. It's not as unsanitary as it sounds -- the primary reason they shouldn't be reused is that the little points get dull quickly, and that hurts more.

But it doesn't seem to bother Penny. In fact, despite the fact that lancing hurts more than the shots (at least in my opinion -- and I've done both to myself) Penny actually kind of enjoys having her blood sugar checked. I suspect that's partly the fact that she loves beepy tech gadgets almost as much as Matt and I do. Her shots don't do anything, but the glucose meter beeps and blinks and flashes!

She loves to wait for the number to pop up and try to guess whether it's high or low. She doesn't really comprehend numbers bigger than about 20. She did figure out that a three-digit number was usually better than a two-digit number, but it leads to weird moments where it comes up at, say, 95, and she'll sigh, "Oh, dear, I'm low." Or it'll flash 315, and she'll chirp, "Oh, that's great!"

Sometime in the next year or so, she'll learn how to count to 100, and then the whole meter thing will be much easier for her to understand.

In addition to watching her blood sugar level, we have to measure the amount of sugar (that is, carbohydrates) that she eats.

If I've learned anything from the host of diets I've been on, it's that I'm really, really bad at estimating servings. My "eyeballed" measurements are often off by as much as 50%. So I bought this digital scale for our kitchen, and I weigh or measure nearly everything Penny eats. We'd been teaching her to throw out the uneaten portions of her meals, but now we're retraining her to just set her plate on the counter so we can re-measure uneaten portions.

I've come to think of this book as the Diabetic Bible.

It's a pocket-sized book from Calorie King that details calories, fat, and carbohydrates for literally thousands of common foods, including listings for a whole bunch of chain restaurants and fast-food places. (Oddly enough, I don't care to use their website to look things up -- I think the organization is wonky, especially for less-common foods. So I use Daily Plate for online lookups.)

We were given the book at the hospital, and we used it the first time before we even left. It's a pretty rare day that I don't use it for one thing or another. Mostly we use it for produce, since the rest of our food has nutrition labels on it, but it also comes in handy if we eat out or at someone else's house and we have to estimate how many carbohydrates are in it.

Here's an example of progress in the field, though. As little as ten years ago, we'd have been forced to completely change Penny's diet to match the regular doses of insulin she'd be receiving. But now, we just adjust her insulin to match what she eats. Counting carbs every meal isn't exactly fun, but it's so much better than trying to force a four-year-old to undergo a complete dietary restructure!

Which doesn't mean we aren't making changes to her diet.

Do you know how much sugar is in ketchup? About 4g per tablespoon. Do you know how much ketchup Penny wants with a standard serving of chicken nuggets? About three tablespoons. For a while there, before she started her honeymoon phase, she was needing a full unit of insulin just to cover her ketchup! Our grocery store didn't carry low-sugar ketchup. In fact, I went to every grocery store in Williamsburg, and none of them carried it. My parents finally found some low-sugar ketchup at their grocery store, which has only 1g of sugar per tablespoon, which reduces Penny's standard "serving" from 12g to 3!

But their grocery store is a little inconvenient for us to get to, so when we go, we buy a lot of it at once -- five or six bottles. Just after our last trip, my parents also discovered that the Super Wal-Mart near them carries low-carb ketchup. (Which, as near as I can tell, is exactly the same thing with a different label on it.) So now we have ten bottles of ketchup in the house.

Finally, we monitor her ketones.

This is a simple urinalysis dipstick test. We should do it more often than we do, I admit. Technically, we should do one of these every time her blood sugar level goes over 300. But we really only break them out if she's over 300 for two readings in a row -- which has only happened once since we brought her home. (We're also supposed to test this more often if she gets sick, but she hasn't been sick since her diagnosis.)

As she begins to slowly climb out of the honeymoon phase, we'll probably try to do them more -- if only to train her how to get the urine sample the test requires.

The tricky part of the test is that you have to compare the strip to the color chart precisely fifteen seconds after dipping it, because the color will continue to darken over time, which can lead to false readings. So we have to keep a watch with a second hand (or this stopwatch) with her kit.

Not so long ago, this was the only indicator that diabetics had of rising blood sugars -- and by the time ketones start appearing in urine, damage is already being done to your system.

So, now that we know what her blood sugar is, how many carbs she's eating, and what her ketone levels are... what do we do with it?

I'll talk about the first part of that tomorrow, in Keep It Down!