We went to Grace's quarterly endocrinologist appointment today. You know, the one we needed to postpone a few weeks ago due to the stomach bug ravaging my household. Well, it was rescheduled for after school today and I'm not sure what I was thinking when I did that. It's 8 days before Christmas, and I'm not done shopping yet. And though I'm holding onto my holiday spirit by my fingernails, I have to admit that exhaustion is starting to set in. That, mixed with a fair amount of liquid holiday "spirits" have left me feeling pickled. But charge on I must, because we have a party Friday night and Saturday night. I'm up for the task, but I may need to stock up on coffee and Advil to make it through.
Back to the endo. Grace's A1C is 6.6. I'm pretty neutral about that number because she's still experiencing frequent low blood sugar episodes. Even though the number is in a great range, it's come at the cost of lots of lows. So that was our major priority to address.
First, we changed Grace's insulin to carb ratio from 1:35 up to 1:50 from 10am to 5pm. We did this for two main reasons. She's dropping like rock between 10am (snack time at school) and noon (lunch). She could be 297 at 10 and 59 at lunch. And this happens regularly. Then she drops between 3pm (after school snack) and dinner. So, clearly, she's getting too much insulin during these times. Since her basal is already only 0.15 during those hours, we're looking to the bolus amounts.
Next, we loosened her target number from 110 to 150 from 9am to 5am. (It's staying at 110 for breakfast because she's so insulin resistant in the morning anyway.) Instead of adjusting her Insulin Sensitivity Factor (set at 125) we decided to just aim higher, as it were.
All these changes, specifically changes that will hopefully raise Grace's blood sugar, have come at a time when I've been re-adjusting my view on her numbers. I used to think of it as a goal. Tight control was the goal. Blood sugars between 90 and 120 was what I was aiming for. Anything over 150 seemed on the high side to me. If I could just wrestle this stupid beast to the ground in a head-lock, keep my daughter's numbers tight and steady, I'd win. What would I win? Not sure. But what I ended up with is Grace not feeling her lows until the 40s. And she's there way more than she should be. Because I can't control it. I can't keep her within 30 points because I AM NOT IN CONTROL.
... cut to me in group therapy, "Hi, my name is Pam, and I am not in control."
So over the past couple weeks, I've felt that need for Total Diabetes Dominance (possible name for my as yet unwritten autobiography) lifting off my shoulders. I would be much happier with Grace's A1C in the 7s and her feeling her lows in the 60s, not the 40s. And to do that we have to raise her numbers. Will these changes be the perfect solution? Not sure yet. I'll know in a couple days. And if we need to adjust further we will. But this is the new me, embracing numbers up to 200 (sheesh, I have to draw the line somewhere). If she's steady up higher, it's much better for her long-term health than ping-ponging from the 50s to the 200s. It's not going to be easy, but if I broaden my range of acceptable numbers, my daughter's health will definitely win.
The apache wars by paul hutton
21 hours ago