Friday, November 5, 2010

An Update on my Type 1 Diabetic....

Yesterday was Ashlyn's quarterly visit with her endocrinologist.
I was pretty much resigned to the fact that because her blood sugar levels have been so up and down the last couple months, that her A1C would be up higher than it's been since her diagnosis in February 2009. 

I haven't been able to figure out why her BG (blood glucose) numbers have been like a roller coaster. 
 It seems that if we don't TOTALLY focus on where she's at every minute of the day, she's either crashing or swinging up really high. 
 It's not unusual for her BG to be between 200 & 300 later in the afternoon every. single. day.
In the morning, she's either waking up slightly high or a little low, and then dropping to around 40 before lunch.
We've tried adjusting her insulin, and her ratios now stand at 1:5 for breakfast, 1:5 for lunch, and 1:4 for dinner.
Her bedtime Lantus dose is 20 units.
To me, that just seems like so much!!
Imagine my surprise when her the results of her blood test in the clinic came back with an A1C of
"Not perfect, but not too bad."
That actually was exactly what it was in August, so I was okay with that.
But I know it's just because her crashes have balanced out her highs.

So the doctor gave us several recommendations to try:

1.  He told us that for some children, the long-acting insulin (Lantus) isn't always as "long-lasting" as it's supposed to be.  So he wants us to split her Lantus dosage to 9 units at bedtime, and 9 units at breakfast.
The idea is that it will cover her better throughout the entire day by giving her some at breakfast so it will last throughout the afternoon when she has been going so high.

2.  We're also scaling back her breakfast ratio short-acting insulin (Humalog) to 1:7.  Again, the idea here is maybe she doesn't need as much Humalog in the morning, hence why she's been crashing after an hour or so.
Plus with the extra dose of Lantus on top of that, she probably won't need as much Humalog.

3.  The doctor talked at length with me about the pros of getting her on either the insulin pump or omnipod.
I've been resistant up to this point, but I'm finding myself warming up to the idea because of how difficult it has become managing her BG levels lately.  I'm wondering if it will actually give us better control?  The doctor seems to think that it encourages "compliance" on the part of the child because it's a little less work (everything is right there hooked on your hip and you just have to push a button for a dose).

Overall, it was an encouraging visit, but a good reminder that this is something that we will always have to pay attention too.  There are no breaks or vacations from Type 1 Diabetes.  
There is no room for complacency.
I'm so glad we live when and where we do to have such technologically advanced methods of caring for our children!!  
I'm so thrilled for wonderful endocrinology team she has and that we have one of the BEST Children's Hospitals just 20 minutes from us!!!
God has everything in control for us,
even when we can't keep things under control!!


Nicole said...

Great Job with the A1C. We are all over the place right now with Cara's blood sugar. We just can't seem to find a middle ground. Either too high or too low :(

We are not on the pump yet but everyone who I have talked to who is on it LOVES it. Good luck :)

Brenda said...

Hi Nicole,
I have heard the same thing, but we're still hesitant about all the transition time involved with it. Not sure I'm ready for all that. I think I'm also more interested in the omnipod simply because it doesn't have all the tubing to get caught and tangled in. I think I probably need to just get over it and think of what will help her more in the long-run.
Thanks for your thoughts!!!

Jessica said...

Hi, Brenda,
Just found your blog and wanted to encourage you that the tubing isn't really an issue, you get used to it. My little one has been wearing Medtronic since 15 months old, and she's now 6 years old. She wears a belt for her Dexcom (held by a pouch) and the insulin pump clips onto the belt, so it's pretty tight to her body. Also, you can wind the tubing up and then clip to the belt. If you wear the belt, you don't have to unclip for the restroom.

Take care!