A Perfectly Imperfect Diabetes Day
Scott Benner
Arden's A1c has been between 5.6 and 6.2 for over four years and while those numbers are pretty amazing... they can also be a bit misleading. So I thought I would share what I consider to be a perfectly imperfect day with type 1 diabetes.
This graph is from 9 am on Friday to 9 am on Saturday and it encompasses a ton of diabetes decisions and their outcomes. Some good, some not so good... all of them will lead to a 3 month A1c average of somewhere around 6. Let's break it down.
The 9 am incident...
Arden left for school around 7:45 am with a stable BG around 110. I gave serious consideration to changing her insulin pump before school because I noticed some inconsistencies with how the site was acting (read: I didn't like the action time of the insulin and though the site may be going bad a bit prematurely) but because of the stability of Arden's BG, I left it on. result, mistake
Here's how I tried to handled it..
After a few small boluses over an hour and a half I stopped trusting the pump site. At this point I wanted to venture to the school and change the Omnipod but I wasn't home. In place of a pump change I began to more aggressively bolus in an attempt to hold things in place. We used a combination of temp basal increases and small boluses. When the time came to pre bolus for lunch I figured that it was going to go one way or the other. Either not so bad or pretty bad. With that in mind, it was time to be extra bold. I prebolused all of the meal insulin plus an extra unit at 11:20 am for an 11:40 meal. You can see on the graph that it almost worked. Alas, Arden's eclectic meal of a bagel, grapes, chips, cookies, carrots and iced tea was too much for even an aggressive bolus (with a bad site). The spike reached 180 (normally there is no spike) but I was still out of town and wouldn't be back until after 1 pm. I guess in reality 180 with all of that food wasn't too bad and it wasn't like I didn't know what it happened or how to correct it. So when I arrived home I decided that instead of bothering Arden at school we would just keep pushing the BG and change her pump when she got home at 3 pm. result, ehh not bad
Pump change at 3 pm...
We swapped Arden's pump as soon as she got home and applied an aggressive bolus and temp basal increase. The idea was to get her BG back and stable as soon as possible. I was willing to add carbs to stop a drop if needed in exchange for a quick resolution to the elevated BG and that is exactly what happened. Two hours later Arden drank 15 carbs to stop the drop and then she went for a short bike ride with a friend. Her BG hung around 70 and so we used a temp basal decrease to help with the bike ride. The basal worked great for the excursion but would later cause a slight rise as we approached the movie theater. result, YEA!
Click to enlarge
Off to the movies...
We arrived at the theater around 6:50 pm. Half of our group went to find our seats and the other half stood in line for snacks. Arden was with me in the snack line. Her Dexcom G6 indicated that her BG was 120 and drifting higher. I bolused 4 units. Arden got a large popcorn to share with her friends, a slurpee and a box off Bunch A Crunch. We added more insulin when we got to our seats in the form of a bolus and an hour of increased temp basal. There was one more small bolus about an hour into the movie. Her BG hung around 165 with a slurpee and an unknown amount of carbs. I liked where we were and expected a BG decline when the snacking stopped. result, hell YEA but the temp basal should have been 90 min.
Bedtime...
Arden's BG settled around 114 as we left the theater and hung there nicely for two about hours. She needed a juice around midnight (still awake with her friends) and we used a combination of temp basal decreases throughout the night. She slept in the next morning and I continued to temp back her basal insulin so she could sleep. result, (after all that) BOHYA!
Perfectly imperfect...
If it's your intention to set a basal rate, count a carb and never think about it again diabetes is going to be a rough ride. But if you're willing to stay fluid, boldly attack problems and work to keep your insulin balanced with your body's needs... things can work out pretty well.
Conclusion...
Throughout the day I never once counted a carb, gave in to fear or considered adjusting our plans. The bike ride may have seem counterintuitive to some but I would never plan for failure. And that slurpee, well, you can eat anything if you time your insulin correctly. Be bold! To learn more about how we manage insulin you can check out the Juicebox Podcast at JuiceboxPodcast.com or on your fav podcast app.
