Relentless

We're going through a stretch of very active diabetes management here, and it's exhausting.

Don't get me wrong.  We're always managing diabetes; all day, every day.  It's just that sometimes it fades into the background a little bit.  This isn't one of those times.

At February's appointment we were surprised by a creep up in my daughter's A1C.  Nothing dramatic, mind you, but worth working on.

Suggestions to address this problem were discussed at our appointment, and we implemented them right away.  Then she started eating.  Everything.  She's growing noticeably taller by the week.  At every appointment lately, the endocrinologist has reminded us that her total daily dose of insulin is likely to double in the next couple of years.  At this rate it'll double by the time we see him again in May.

Her basal rates and insulin to carb ratios are going up and up. With these changes come increased finger sticks and dexcom alarms, the return of the log sheets, and an extraordinary amount of thinking.

I'm trying to meal plan and grocery shop more carefully too.  Countable carbs and balanced meals are important so that we know if the insulin changes we're making are right.  The fewer variables in that equation the better.  I'm also trying to fill her up, so that she's not looking for a snack an hour after dinner. If she does want a snack, I want to have healthy, filling choices on hand.

I'm hearing from the nurse's office at least once a day for a high or a low.  Then she's at play practice until five or six o'clock most days after school, so we're managing snacks and dance induced lows via text all afternoon. Meanwhile we're spending time figuring out how to include her diabetes equipment in her play costume. But who doesn't love a challenge?

The sedentary lifestyle of winter is giving way to the activity of spring.  Yesterday was the first outdoor recess since November. She's walking home again when she doesn't have play practice.  Schedule changes and field trips are creeping back into the school days.  So are juice boxes.

Factor in what feels like more than our fair share of diabetes flukes like the other night's 2 a.m. site change, and it feels like it's all diabetes, all the time here.

Which it is.

Logbook?

I discovered something quite by accident the other day.

We haven't kept a logbook all summer.

It seems like this should have been a conscious decision.  It might have followed a period of diabetes contemplation and culminated in a dinner table conversation with the family.  "What if we took a break from the logbook this summer," I might have said, sounding very wise.  "The meter has a history, and even some charts and graphs we can use.  But maybe a break from writing down every number would be good for our mental health."

That's not what happened.  Instead we finished a packet of stapled together log sheets (our version of a 'book') and I recycled it.  Maybe we were headed on a trip.  Maybe I was quickly cleaning up for company. Whatever the circumstances, it simply disappeared.  And apparently that's the last I thought of it...until today.

I spent some time last week tidying the little area in our kitchen where we keep the calendar, the grocery lists, scrap paper and the most urgent of mail and school notices.  I got to the bottom of the back-to-school fliers and recycled a bunch of old notes and receipts. The area looked oddly empty, like there was more space than usual, but I didn't give it much thought.

It was when my daughter got home from school that it hit me.  As she checked her blood sugar for snack, I asked what her lunch number was. I felt an urge to write it down. Suddenly it clicked. That empty spot was where my eyes looked for that familiar chart.

Did I run right to the the computer to print a dozen more log book pages, happily stapling them together and scanning the meter's memory to catch up for the week?

Um...no.

We may ultimately end up returning to that little packet of paper on the ledge, but if it fell so quickly from our collective memory, perhaps it wasn't as useful as we thought it was. First, there are things to consider.

Do we really need to document every number in the first place? Or is a quick glance at the meter's averages by time of day enough to help me spot a trend?  Did this summer's lack of focus on individual numbers allow us to see the forest instead of analyzing every tree? Looking back, I know that I've made insulin adjustments despite the lack of handwritten data.

If we do resume a formal system, maybe it's time to consider some tech-based tracking options, like downloading software or an app. Maybe we'll even give the equipment that came with the pump another go. 

There are surely benefits to documenting numbers. There are 3 of us living here, all interested in my daughter's blood sugars, so it's a communication tool.  I can know the lunch number at school. My daughter can know what she was at 2 a.m.  My husband can check the dinner number before making a late night correction.  It also provides a historical picture, helping us spot changes in blood sugar trends and make needed adjustments.  It encourages smart choices when, for instance, a glance at the post-cider donut 300 provides a reminder to think twice before indulging again. 

While I realize these may turn out to be a rhetorical (ridiculous?) questions, I'll throw them out there anyway:  Do you love your logging system?  Do you have one you couldn't live without?  Should we just go back to our messy, easily forgotten log sheets?  Doing nothing but relying on the meter's memory seems like not enough, but I'm not sure where we go next.

Analysis

The January Diabetes Social Media Advocacy blog carnival post asks me to fill in the blank: 'Stiving for ......... in 2013.'

'Analysis' is the word which best fills in the blank.

I tend to go in spurts in terms of how much time I spend on my daughter's diabetes.  I don't think this is unusual.  I would imagine phases of simply reacting to numbers and moving on occur for many people who live with diabetes. There are other things going on in life, and many of them are more fun or at least more interesting than sorting through a week's blood sugar log.

To be clear, we don't ever stop managing her diabetes.  The finger sticks, carb counting, and bolusing continue all day, every day.  The 2 a.m. checks happen.  I continue to be alarmed by and to react to very high or very low numbers.

What I don't do consistently is stop to evaluate the overall picture. I'm certain we could eliminate more highs and lows if patterns were picked up earlier than they often are.

Eventually, something will move me to action.  It could be a week of constant calls from the school nurse's office or a series of sleepless nights.  I'll then take a long hard look at the numbers and make some adjustments or call the endocrinology team. Yet analyzing those numbers more regularly could quite obviously lead to better blood sugar control, resulting in better health.

With a growing 'tween,' adjustments are needed more often than ever.  Therefore, 2013 seems like the perfect year to adopt a goal of weekly blood sugar reviews.

What will a consistent weekly diabetes analysis yield?  Fewer calls from the nurse's office?  More sleep?  Fewer hours of my daughter feeling sluggish from high blood sugar?  A grocery savings on juice boxes?  More productive endocrinology appointments?  A lower A1C?

I hope it's all of the above.

“This post is my January entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2013/january-dsma-blog-carnival-2/“

Back On The Wagon

Trying to get those numbers on paper again after weeks of summer fun distracted us from the task.
The next step will be to make some sense out of them.
So far it appears there are some nighttime basal tests in our future.
At least it's the perfect weather for sugar free popsicles!

Reaction Time

A favorite mantra of our first Certified Diabetes Educator was, 'one day does not make a pattern.'  She was right.  One or even two unpleasant 250's could be caused by any number of factors: a bad site, a new cereal, an oncoming illness, bad luck.

Seven makes a distinct pattern, though.  In most cases, three or four should really be enough.  Yet sometimes we're a little slow to react to patterns, particularly of high blood sugars, particularly at night.

As a child with diabetes grows, insulin needs grow too.  The only way to know when to make adjustments is to watch for strings of high blood sugar. 

If the issue is occurring during school hours, I get to work pretty quickly.  The daily 10 a.m. and noon calls from the school nurse begin to annoy me, and I act. 

Overnights, on the other hand, are my downfall.  Regularly checking blood sugars during the night is not the problem. My husband always visits her before he goes to bed, and we check again at 2 a.m.  We even correct highs at those times, though not too aggressively.  It's the next step that trips us up. Any significant changes in insulin during the evening or at night require more work and less sleep.  The dangers of nocturnal hypoglycemia are real.  During the day, my daughter can tell us if she feels low, or someone around her should notice the signs. At night, she's asleep, alone in her room. Therefore overnight changes must be done slowly, and with more frequent monitoring.  It takes many incremental changes to see results.

The coffee budget becomes strained.

Yet letting my daughter's blood sugar linger in the 200's all night is clearly not a better choice, so eventually we address it.  I just procrastinate a bit, rationalizing that I need to make sure it's really 'a pattern.' 

Reacting to these numbers before a week or so has gone by is my one thing to improve for diabetes blog week.