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Thursday, January 17, 2013

(Over)-Avoiding Lows & the CGM

I avoid lows like the plague. The lowest number I have seen in the last year or so was 77. And while I'm happy about that, I am not so happy about oftentimes running in the 160-220 range, with my A1Cs over the last few years firmly planted around 7.5-7.8%. I know that's not horrible, but I also know I can do better. The truth is I read so many posts about devastating lows other T1s have (sometimes frequently it seems) and it makes me feel super guilty that I am able to avoid that. But then I also hear about all the A1Cs in the 6s (and lower!) and I feel even more guilty for running high a lot of the time (even if it's not super-high)...

The truth is my A1Cs were better when I didn't stalk my BGs like I do today. I started stalking a few years ago with the main goal being not going low, and while I have successfully achieved this, I have also raised my A1C and I see the 200s way more often than I should. My endo is happy that I have (almost) no lows and he is also happy that I don't swing wildly up and down all the time. But I know that (on average) my numbers should be about 50 points lower.

For some time, I avoided the idea of a CGM because I didn't like the idea of something being attached to me. But I must say, testing 15-20 times per day (sometimes more) took it's toll on me emotionally (and financially). Furthermore, running high during times when I can't test all the time (like when I am teaching) due to fear of lows is bad and I know this. So finally, a few months ago, I got setup with the Dexcom Seven+ and I absolutely love it. Finally, I have some peace of mind when I am lecturing or hiking or chasing my dogs. Finally, I can give my fingertips somewhat of a break. And most importantly, I look at the graph and there is no denying what needs to change.

In the last few months, I have been able to push my numbers lower than I have felt comfortable before - i.e. I used to correct 90s and aim closer to the 150s before the CGM. Today, I feel much more comfortable with the 90-120 range. That is not to say I come close to staying there the whole time, but I have re-evaluated by goals from just keeping my BGs under 200 overall, to aiming for pre-meal values under 130 and minimizing post meal peaks to 180. Of course, I am not always successful, but the CGM has really made me reconsider some of the misconceptions I had about my BG trends. I have yet to have my A1C checked after starting on the Dexcom system (that's coming up next month) but I am (cautiously) optimistic. Also, I have to admit that the Holidays still kicked my ass this year (Dexcom notwithstanding) and I was totally guilty of rescheduling my appointment from 1/7 to 2/18 in an effort of avoiding disappointing myself and my doc... =)

Thursday, January 3, 2013

T1D: Things They Never Told Me

When I first started insulin treatment some 6 years ago, I naively thought it really was as simple as a carb-to-insulin ratio that when followed and timed properly would magically result in close-to-normal, steady blood sugars. I thought this, because that was basically what my healthcare providers told me - the only thing I was fore-warned about were the symptoms of low BG...

Looking back, I shouldn't have been surprised that after getting off a trans-atlantic flight to Spain, my numbers were consistently and annoyingly high for a few days... Or that after walking around and sweating in the Costa-Rican heat for hours, my seemingly non-symptomatic low of "37" (the lowest number I've ever sighted) was probably to be expected... Or that dehydration will mess with insulin activity... Or that I need about 40% more Humulin R to cover my meals while driving cross-country... Or that drinking alcohol can/will (depending on the amount of OH & carbs consumed of course) make your BG plummet, sometimes like 4-8 hours later (something college students should probably be aware of)!

This (I hope!) is not be the case for everyone, but I never received information when I was in the hospital learning to treat for the first time to what degree activity and stress levels (as well as simply the TYPES of food we eat, not just the CARBS) impact BG levels. Most of these things, I figured out as I went, and still learning everyday.

I'm not so much complaining about my healthcare providers - they suggested meeting with a nutritionist, and I got the initial free visit, but not having regular meetings as part of my insurance coverage, I obviously opted out. Once I realized that low BG (and BG levels in general) are a "serious matter" (understatement?), I was ever-so-grateful to have the internet to be able to look up all this info as well as compare notes with and meet fellow PWDs... Also, grateful to have the Dexcom technology - I know it's not perfect, but it makes my life A LOT easier.

Having said that, I extend my utmost respect to parents of children with Type 1 Diabetes... At least when I fuck up in my own D-care, I laugh it off (most of the time) and move on (always)... I can't imagine what it would be like if it was someone else in my care: I was too old for parental D-care (being 18 y.o. @ dx), but I think all the T1D parents (many of whose blogs I've been reading) are amazing!

Con mucho amor - and remember: do you own research, pay attention, and don't forget to walk that Dragon!