We've been on a decent run of late which is why I have not posted in a while. Sure, there are highs and lows, mistakes made, settings that need to be changed, etc, but no sicknesses and nothing too dramatic -for us at least. :)
I thought I'd give a little overview of how/why we treat K the way we do. Again, I am not a doctor but I thought I'd give an overview so it's easy to digest for those who are confused by what we do or want to understand it better. So, what is "good management"?? Children's Hospital Los Angeles is on the cutting edge of research. We are very comfortable with their guidance of "do this and your child will be healthy (now and in the future)". It's just the way it is: the more often t1d patients check their blood glucose (BG), the better (lower) their A1C, which is a test reflecting the average BG level for the past three months. The higher diabetes patients' A1C levels are, the poorer their blood sugar control and the higher their risk of diabetes complications (which include progressive damage to body organs like kidneys, eyes, cardiovascular system, and nerves). We try not to think about these things, but it's because of them that we take such stringent care of our daughter.
People who do not have diabetes have a normal BG range of 70-120 mg/dl. The target BG ranges for people with t1d will vary based on age, weight and other factors. K's target range is 70-130 mg/dl. There are so many factors that influence a person's blood sugar that it is incredibly challenging, if not impossible, to be as effective as a pancreas. Factors such as how much and what kind of food she eats, sleep (or lack of), activity, exercise, emotions, stress, bad dreams, hormones, and MORE all play a role in how much insulin the body needs. We have to predict these things before giving her (synthetic) insulin, which although is an amazing, life-saving invention, is not the same as the insulin a healthy pancreas makes.
Because of the various factors affecting BG levels, we (as in all t1d parents and patients) are too rarely "right" - ie she is more often out of the ideal zone than in it (or it's at least 50/50). So, the reason for the frequent BG checks is to "correct". If we check often and immediately correct her BG (with insulin to bring down [the more frequent occurrence] or sugar to bring up), she'll have only been high or low for a limited amount of time (rather than through the night, say). We do feel like rock stars when we go a day without highs or lows, but it is infrequent!!! As an example of fluctuation - K had the same exact breakfast yesterday and today. When she was checked mid-morning at preschool yesterday, her BG was 151 mg/dl; she was given insulin (via her insulin pump) to bring her BG down. Today, also at preschool at nearly the same time, her BG was 55 mg/dl - and she was then given glucose pills to bring her up. Why? dunno - but we'll keep an eye on it to see if doses need to be changed - and we're just happy that we checked her!
To explain "checking" and frequency: We check K's BG with a lancing device (the finger pricker) and glucose meter when she wakes up in the morning, before eating, ~2 hours after eating, before/after exercising, during the night, and anytime she seems too low or too high (the latter of which is still hard for me to identify and I don't always get the first one right either). In a typical 24 hour period, we usually use up at least eight of her little fingers. Luckily, she doesn't mind it in the least and it's only frustrating for her if she needs to stop doing something to wash her hands and be checked.
The reading of the glucose meter is how we determine if K needs "correction": more insulin to lower her BG, or fast acting sugar to raise her blood sugar (we use juice or glucose pills - the amount of which depends on her BG). If she is about to eat, we also have to factor in the carbs she is about to eat. We calculate carbs mostly by using labels, apps on our iphones/pods, weighing foods on our fancy nutritional scale, and experience (like I know that K's "favorite fruit" -an orange- has about 15 carbs for the whole thing). I'm thankful that in California, chain restaurants must provide nutritional info upon request. However, it's annoying when I do and our server points to the calories listed in a menu. I say, in a nicer fashion, "I don't give a rat's ass about calories. I want to know your carbs" and let them assume I care about that new French diet fad. The amount of insulin she gets per gram of carb (the insulin:carb ratio) varies depending on the time of day and is always something we're tweaking anyhow, meaning if we find she's running low for a couple days after dinner, we may increase her ratio for dinner time; or if she's running high we'd lower the ratio. We have adjusted these ratios more times than I can ever count. The pump makes all these calculations much easier, but we still have to count carbs.
Oh my, I have provided more info than I intended to and I hope I did not make your head spin too much!! Feel free to ask questions or leave comments.
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