A few days have passed since my last post; I thought that might be the case what with a school camp and a weekend away. As it’s been so busy it’s passed in a bit of a blur, and I always find it hard to reflect accurately on the ups and downs of each day. I even find it hard on a day to day basis to be accurate I guess… Once I’ve gotten over a drama it can be quite hard to revisit!
The camp, in terms of my diabetes was quite challenging. I had a lot of hypoes. But then I was expecting this. It’s happened before and my daily control is not good enough on a normal day, let alone on one that as far out of the norm as a school residential, to enable me to pre-empt the effects of what I am doing. It's not that I'm not trying, but I do find it difficult. You see stress plays a major part in my control. The hormones your body releases when you are feeling stressed inhibit the action of the insulin, thus making blood sugar levels rise. But then exercise (or constantly being on-the-go) has the opposite effect: yet more variables to add to the balance and ones I find almost impossible to work out as it stands.
The good thing is that I’m getting to grips with the new units of measuring my BG levels. I am almost completely weaned off my old (wonderful!) BG meter and am now relying on my new simpler meter combined with my App. I am still being very diligent in recording everything on the App, which is where I usually fall down after a week or so. But a week in and I am still going, maybe there’s hope?!
The weaning process has been slow and I have been well and truly out of my comfort zone. At first every time I looked at the screen and saw a 3-digit number I panicked! Slowly the reverse is becoming true! Now, a 2-digit number is starting to represent a hypo so I am getting there! I am, at the moment being very general with my understanding of the readings: a number below 100 is heading into the hypo regions; a number in the 100s is acceptable and anything above 200 is bad. This is not strictly right, but a ball-park figure is good enough for me at the moment.
The App is great for three reasons:
1, when I enter my BG reading into it, it automatically tells me how much insulin I would need to take to correct it back to an acceptable range. If it is too high that is. If the correction dose is small I can tell that it’s only just out of range without really understanding the exact value of the reading in old money. Going the other way, once the reading hits 72 mg/dL a red warning flashes up telling me to eat – quickly!
The second reason is that when I open the App it tells me immediately how much insulin is still acting in my body. This is approximate s it is highly unlikely that I set the meter up perfectly to begin with, but again, it gives me some sort of idea. If I am hypoing and I still have 6 units of insulin, say, on board, that is not a good thing! It means if I don’t eat enough I will be more than likely to have another hypo later. It is very clever though. It logs my hypos and if I have had a hypo within the last 6 hours is adjusts my dose accordingly by giving me slightly under the dose it would normally recommend (there is also a box to tick if you have had “More than 2 drinks in the last 4 hours”; normally at that point I am no longer testing my BG!)
Thirdly, it does all sorts of number crunching with the data. So far it is looking like this:
· My average BG reading is 147 mg/dL
· Number of readings: 46
· Ave no. of readings per day: 6
I have always been told off for testing too much. I never really understood why this was a bad thins, other than the possibility of micro-managing my BG levels, until I did 5-day DAFNE – dose adjustment for normal eating – course where I was told how precious our finger tips are. Without actually saying it, I think the nurse was referring to potential future eye problems and this scares me. I now never use my index fingers to test. In her words, “they are too precious.”
· Ideal readings (72-144): 39% (At least there are some!)
· Ketone warnings (>306): 0%
This is a good things. Ketones are nasty little blighters. They lead to something called ketoacidosis which causes a diabetic’s blood to turn acidic and it has all sorts of dire consequences. Ketones are a problem when BG levels are high and often occur when we are ill. Being ill is a lot more complex for someone with diabetes, especially where vomiting is concerned: not being able to hold down food is a big problem.
· Hypo warnings (<72): 12%
This needs to be lower. Ideally 0%.
· Estimate HbA1c: 6.7%
Now. This is good. But as my doctor once told me, just having good numbers doesn’t mean it’s actually good. It could just be this low due to the number of hypoes I’ve had, the good old law of averages!
“HbA1c occurs when haemoglobin joins with glucose in the blood. Haemoglobin molecules make up the red blood cells in the blood stream.
When glucose sticks to these molecules it forms a glycoslated haemoglobin molecule – also known as A1c and HbA1c. The more glucose found in the blood, the more haemoglobin will be present.
Due to the fact that red blood cells survive for 8-12 weeks before renewal, by measuring HbA1c ,an average blood glucose reading can be returned.
For non-diabetics, the usual reading is 4-5.9%. For people with diabetes, an HbA1c level of 6.5% is considered good control, although some people may prefer their numbers to be closer to that of non-diabetics.
People at greater risk of hypoglycaemia, may be given a target HbA1c of 7.5% to prevent too many low blood sugars from occurring.
HbA1c refers to glycated haemoglobin, which identifies average plasma glucose concentration.”
Basically, it measures the amount of glucose that is being carried by the red blood cells in the body and because they live for around three month it gives you an average picture of your BG levels over this time. If your BG levels are consistently within range, your HbA1c will reflect this. Unfortunately, if your BG levels bounce from hyper to hypo, your HbA1c will also, more than likely, be close to being within range. Therefore, the bouncing is the thing to avoid…
So. From here on in, my targets are to avoid hypoes and (still!) to get my morning BG levels down to within the acceptable range. This morning they were high (around 14 in mmol/L, I did test in mg/dL but the numbers escape my brain on recall!) Tonight I am going to test before bed to see what happens over night. And, if I remember, I will leave my meter in the loo so if I get up in the night I can test. We’ll see!
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