Diabetic rapper

If Mark was a rapper, his name wouldn't be 50 Cent -- it would be 50 Carbs.

That's his new favorite go-to number for his lunch carb count. It's not the correct number, it's just his favorite.

Let me backtrack...for people with dia betes, the best way to manage their blood sugar is to count carbohydrates and give themselves the correct amount of insulin based on that count. So before Mark puts anything into his mouth, we add up all the carbs.

This is not a difficult task. Luckily, Mark eats mostly the same foods, so we can estimate the carb count of just about any normal, everyday food. The only time Mark has difficulty is when it comes to veggies or other foods he dislikes--suddenly, he couldn't guess the carbs if they were written in neon colors on the packaging. But stick a couple donuts or piece of cake in front of him, and he can tell you the exact carb count based on size, weight and amount of frosting. He's even more accurate when he's cramming the second piece into his mouth.

Because he's a kid and has more important things on his mind at lunchtime (namely, lunch), I try to make things easy for him. I send a paper to school everyday with the lunch items and carb counts. All he has to do is test, look at the paper, and put the numbers into his pump. As long as he follows the plan, everything's cool.

So I was a little shocked when he called after school to tell me his blood sugar was 307! (It should be between 70-150).

"Did you bolus at lunch?" I asked.

"Yup!"

"Did you eat anything you weren't supposed to?" I asked.

"Nope!" he answered.

"OK, then just correct it," I answered.

I gave him a free pass that night -- a chance to be honest with no repercussions if he really had eaten something he wasn't supposed to. He insisted he hadn't.

And so it went for a few more days -- high numbers at school, followed by lows at dinner. It wasn't until I received an email from the school nurse that the light clicked on.

"Mark's been forgetting his paper, and just bolusing for 50 carbs," it said. "Just wanted to let you know."

Mystery solved! Mark wasn't sneaking food, he just wasn't giving himself enough insulin -- his lunches were 70 carbs, not 50.

My first inclination was to yell at him for being lazy. I mean, seriously, how hard is it to take the paper out of his pocket every day to get the carb count??

But I realized getting mad wouldn't solve the problem. Mark would just argue back, I'd get madder, and he'd still lose his paper everyday.

So I gave him a dose of tough love. If he wanted 50 carbs, he'd get 50 carbs. Which happened to be about half a sandwich less than he was used to. Which meant he'd be hungry. Which is a tough lesson, but sometimes the only way to talk sense into Mark is to speak directly to his stomach.

"Hey, I only got half a sandwich for lunch today!" he complained at home.

"I know," I told him. "Half a sandwich, 20 carbs. A banana, 30 carbs. I know it's too hard to remember your paper, so I'll just give you 50 carbs from now on, so you don't have to remember."

"But I want a whole sandwich!" he cried.

"Then bring your paper home," I said. "If you use it, I'll send a whole sandwich again. And if you don't -- well, at least you can use your favorite number every day!"

Guess what was the first thing he handed me yesterday? Yep, his paper -- with his blood sugar and insulin units written down on it!

I have to stop reasoning with his head, and threaten his stomach more often...