Life gets in the way.

Sometimes, something comes along in life that eclipses everything else; this can be momentary or long term. For me, it’s been for the last few months, since my last post. Even my diabetes had receded to the darkness in the back of my mind somewhere. But, looking back now I can see how pivotal the time has been in terms of my blood sugars. I have a lot to share.

Slowly, I have been working with Lisa at Integrated Diabetes Services to tune up my doses, and the amazing thing is that I am beginning to get somewhere. I have made a number of changes since my last post. I have decided to stop using my RapidCalc app for a while. I was finding that I was blindly putting in numbers and had no real ownership over them; my ratios were the opposite way round to the norm and I was effectively guessing the impact exercise was having on me.

So I’ve gone, voluntarily, back to the diabetes dark ages and begun to calculate my doses myself. Initially this was quite daunting, especially when I remember how relieved I was to find the app in the first place. The calculations stretch my brain, but what they also do is make me stop myself in the whirl of the school day: I now have to force myself to take the time to think about what I am eating, record my doses and actually eat.

When I eat, I now have to:

1. Test my blood (no change there!).
2. Subtract the number I want my reading to be (117) from the number I am.
3. Divide the number I get by 40 (my current estimated correction dose, this should bring my level down to the target)
4. Count my carbohydrates (more on this later)
5. Divide the grams of carbohydrates by the mealtime Insulin:Carb ratio (5.5 at dinner time, 9 at lunchtime, 8 at breakfast if I haven’t exercised the previous day, 11 at breakfast if I have exercised the previous day)
6. Add the two numbers together
7. Subtract 10%, 30% or 50% if I am planning to do exercise in the next 1-1.5 hours
8. Round to the nearest whole number
9. Inject!

Now... This sounds worse than it is...Actually, it’s been surprisingly easy. It just means that wherever I go now I am accompanied by my lime green notebook and pen! And I am trying to remain realistic: I will not ALWAYS feel like calculating in this way, or recording. So if I don’t, I don’t. I have always made myself feel guilty for this in the past and madly recorded up to 3 months’ worth of readings and food intake the night before an appointment. But this isn’t the purpose of recording these, the purpose is to learn from the records  step by step. And, over the last few months, I have realised that not keeping perfect records is ok: life does get in the way, for better or worse.

To help me keep better records, I have tried using Google Spreadsheets, attached to my personal email and accessible to me wherever I am. Still, this has not been manageable enough. So this week, following a meeting with Lisa, I decided to fully geek out and use the auto-sum functions to do my calculations for me.

The columns are linked as follows:

• I enter in my blood sugar, and the correction (C) column takes away 117, my target level, to leave the correction factor.
• I then have to enter in the amount of carbohydrate (CHO) in my meal/ snack.
• The C Dose column then divides C by 40 (my personal insulin sensitivity) to calculate how much insulin I need to take to bring my levels down to the target range.
• When I enter in my ratio, the dose column then divides the CHO by my ratio to figure out how much insulin I need to cover my food.
• The DOSE column, then adds my correction dose and my food dose together, before rounding it to a whole number.
• If I am planning exercise, I then enter in the details and the activity multiplier in the Factor column.
• The FINAL DOSE column the multiplies my DOSE by the Factor and rounds it to a whole number to give me the final dose I need to take.

While quite complex, this method means I still have to input data (my blood reading, CHO, I:C ratio and the exercise factor) giving me control over the calculations, but the spreadsheet does the maths for me: the perfect partnership!

Here is a screenshot of my geeky handiwork:

Click here to see the actual Google Doc; the auto-sum records are only from May 15th on and if you would like to access it you will need a google email account.

The upshot of this is that, with the regular help of a professional, I finally feel in control of my blood sugars. They are not yet perfect, but they are better than they have been for a long, long time, maybe ever. And, I understand them; I can account for hypoes and highs in a way I haven’t been able to do before.

Lisa has also introduced my to carbohydrate factors and meal adjustments for exercise which are helping no end.

A carbohydrate factor is the amount of carbohydrate a food has per gram. When I’m at home with my food scales, I can use this to figure out how much carbohydrate is in what I’m eating by weighing the portion and multiplying it by its carb factor. I now have a number of sheets full of lists of foods and their carb factors which are quickly becoming indispensable!

The exercise adjustments are also helpful: a numerical way of incorporating exercise into diabetes calculations. The insulin dose is multiplied by the ’activity multiplier’ which depends on the duration and intensity of the exercise if exercise is planned for within 2 hours of eating. Which is something else I’ve learned and applied over the last few months... The best time to exercise is within an hour and a half to two hours after eating, this requires mealtime adjustments (hence the activity multipliers) but ensures that there is enough insulin in your system to allow the muscles to use the glucose in your blood stream for energy. And, so far, with some tweaks along the way, it seems to be doing what it says on the tin... I am, for the most part, avoiding hypoes, and ending up with a reasonable level post exercise. Thus, I am exercising regularly, and feeling confident to do so.

My final breakthrough over the last week or so, was an overnight basal test... My blood sugar before bed was 92 (5.1 in old money), 114 (6.3) at 3:00 am and 115 (6.4) on waking. An overall rise of a respectable 23 mg/dL (1.3 mmol/l): pretty darn good and completely unheard of! Now, I just need to do a second one to check that it wasn’t a fluke...

So, all in all, while life has not necessarily been smooth sailing over the past 3 months, I am at least feeling like I am making headway with my blood sugar control. My last HbA1c in April was 7.9% (down from 8.4%): nowhere near in range, but going in the right direction!