Topic: ☕Food Stories

{Editor’s Note: This story was filmed four years ago, and insulin still remains the main treatment for Type 1 and Type 2 Diabetes. There is no cure. For those interested in finding out more about Type 1 Diabetes, or ways you can help fight this disease, please visit the Juvenile Diabetes Research Foundation International for more information.}

Cooking Up a Story: Stories

Calvin is a 10-year old boy with a deep enthusiasm for life. But every day is a constant battle against an unrelenting foe. One that requires constant vigilance and treatment; an enemy that science can not—as yet—defeat. Calvin has Type 1 Diabetes: this is Calvin’s War.

Spending a day with Calvin was an eye opener.

First off, I want to say something about the ‘hi’ reading he got on his pump that morning. I traded emails with his Dad later, to understand what had happened and this is what he wrote back: The “hi” reading doesn’t happen very often (thank goodness)–that means that he’s over 500 and means that it’s time for a big-time fire drill to get him down immediately. Anything over 200 is bad news, and over 400 is awful. When it says “hi” it’s almost time to panic. He also later told me that was about the 4th time in 3 years he had a ‘hi’ reading.

It was a Saturday morning. I grabbed a cup of coffee and the newspaper, and flipped through the pages. It caught my eye on the front page of the Living section A Day in the Life of a Diabetic, by Calvin Kocher (see his original article below). I knew a little about diabetes, but I had no idea what a day entailed. I had no idea how critical everything he ate and did could affect his body. Afterwards, I sat there and imagined doing what he did everyday.

With the article in mind I pursued filming a day in the life of Calvin. Again, I go into a story with a general (unscripted) idea how it will turn out, but stay open to what occurs. Though I spent the day with him, so much happened that morning at the soccer game–getting a ‘hi’ reading, taking a bolus of insulin to get it down, discovering it was a false reading due to a dirty finger, drinking Gleukos and Gatorade to counter the extra insulin, and still wanting to play soccer–I decided to concentrate his day around his game. It’s just a small piece of his life, but what a slice it is.

Recipe from the show: Nasi Goreng (fried rice).

A Day in the Life of a Diabetic, by Calvin
published in The Oregonian, Living Section, May 6th, 2006

Picture yourself like this: You have sudden thirst all the time, you’re always hungry, you have blurry vision, have lost weight, and suddenly have urination problems. You go to the hospital, and your doctor says you’re diagnosed with diabetes. Then you go to sticking yourself with a 1⁄4-inch long needle 50 times a week. That’s what happened to me and 23 million people all over the United States of America. Are you scared now? Wait until you see our average days!

The day starts at 2 o’clock in the morning for me, even though I’m not awake. My dad comes in and tests the amount of sugar I have in my blood. Oops. I’m high. See, the normal range is 80 to 180. I’m 274. I have a portable I.V. that I carry in my pocket called a computerized insulin pump. It gives me insulin, a hormone I need to stay alive, constantly throughout the whole day, which is connected by means of an infusion set.

To give an example, insulin is like a drawbridge that connects the red blood cells to sugar wanting to get in. The insulin “drawbridge” lets the sugar in, which is then converted into energy. However, when you have diabetes, you don’t produce insulin, so the sugar can’t get in over the drawbridge. When your drawbridge is up, the cells are literally starving all the time because they are in need of glucose, even though the blood is thick with it. The body wants to wash out the extra sugar, and so you need to drink and go to the bathroom a lot. A lot can go wrong when that drawbridge isn’t working properly, so my pump puts in insulin regularly via my set, which is an infusion set in my body for up to five days at a time. This constant input of insulin is called a basal rate.

So, back to our 2am blood check. Since my blood glucose is high, my dad gives me enough insulin to get it in range. You figure out how much insulin to inject by subtracting your goal from the high blood sugar, and dividing by the patient’s correction rate. My goal is 135 and my correction rate is 50. So 274 (my reading) – 135 (my goal) = 139 (the amount I need to come down). Then he takes the 139 and divides it by 50, which equals 2.78 units of insulin. So, he programs my insulin pump to inject that much insulin into me via my “set”, which is called a bolus since a lot of insulin is being injected at once, and everything is normal and peaceful…until morning comes.

Today is a Saturday, which means it’s a soccer game day. The game is at 11 o’clock. I wake up at about 9:30, get my contacts in, and head downstairs for breakfast. I read the paper as I test. Oh, look, Phoenix won! BEEP-BEEP-BEEP! That’s my meter! I’m 146. Perfect! I’m having 2 waffles, 30 carbs, honey, 15 carbs, butter, and milk, 15 carbs. So 30+15+15=60 grams. My breakfast ratio is 1 unit of insulin to 10 carbs, so I bolus 5.75 units, because I’m going to be burning a lot of carbs with all the exercise at the soccer game. Then I eat, bolus and we head off to the soccer game.

As we get there, I shed my sweatsuit and head off to warm up before the game. Then, just before we take the field, I test. 131. Normally, this would be perfect, but since I’m going to be exercising, I swallow a drink of my Gatorade® and jog onto the field.

At halftime, I test again. 187. Good! I don’t do anything. But then, later in the half I feel low. You know what it feels like to be low? It’s like running a marathon with only water to quench your thirst. You’d feel woozy, ready to drop, and ravenous, right? That’s what it feels like to be low. So, my dad calls me off the field. Yikes!!!!! I’m 39! I quickly slurp my whole Gatorade®, and ten minutes later, after testing to affirm that I’m at a good level again (107), I go back on the field to savor the last five minutes of a 6-2 win.

At the end of the game, I test again. Oh, good! I’m 156, so I can eat the after-game game snacks: Tropicana® fruit punch and a bag of chips. I will need to bolus for them. So, 30 for the juice and 15 for the chips is 45 on a 1:15 mid-day ratio, that’s 3 units. I bolus, and then, since I was exercising, I activate a setting on my pump that, for a short time, lets me reduce the basal rate of insulin my pump puts in to a fraction of what it was, called temporary basal rate. The basal insulin is the amount of insulin that my pump puts into my body continuously. My normal basal rate is about .8 units per hour.

We then, in good spirits, go to Outback Steakhouse™ for lunch. I order a steak, a baked potato, diet Dr. Pepper®, and a sundae. Then, after we order, I test: 126, and when I see the food, I bolus: 60 for the potato and toppings, 0 for the steak and the soda (they are carb-free), and 60 for the sundae. On a 1:18 ratio is…6.67 units. So I bolus and we dig in to our food like stray dogs at a deli.

At three o’clock, I go outside to eat a Popsicle and grab a bag of pretzel/cheese sandwiches and relax in the hammock. This is a snack I don’t have to bolus for. I look forward to it every day. Eating without testing and bolusing. It seems so normal for everyone else, but for me it’s a luxury.

At dinner, we’re having creamed corn, my mom’s really good fried potato slices, and steak outside. I rack it all up. My number’s a bit high 324, so maybe I shouldn’t have had the popsicle…. Anyway, so 324-135=189, and 189÷45=4.2 units, plus the meal. Milk’s 10, potatoes are 50, creamed corn is 30, steak is 0, and a fudge sickle is 15, so that makes 105, divided by my dinner ratio, 1:20, is 5.25 units plus the 4.2 units from earlier, which makes 9.45 units. It’s a lot of insulin, but that’s what I need. I bolus, and we eat. Later, right before I go to bed, I test. Terrific! I’m 110, so I eat a half a banana (15) so I won’t go low overnight. Then I go to bed, waiting for yet another eventful day.

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