Breakfast Woes.

"I think that's too many carbs for you right now."

My endo and I were reviewing several days' worth of Dexcom graphs, and it was glaringly obvious where my most consistent challenge lies: breakfast.

Overnight? Coasting beautifully. After lunch? No problemo. Dinner? Even that's not too bad. But breakfast? Breakfast is a jerk. Breakfast is a bastard who steals my lunch money and throws spitballs at the back of my head all morning. We hates it. We hates it forever.

"So what kind of stuff are you eating then?", my doctor asked. Every single day for the past handful of days, I'm soaring above 200 after my daily oatmeal, raisins, and glass of milk. It's a breakfast I switched to a couple of weeks ago as I had gotten tired of my usual egg casserole, and oatmeal is a breakfast I can eat while driving to work super easy and quick to make during my morning rush. I'm also trying to balance the whole "you're supposed to eat more whole grains and fiber and the baby needs carbs so quit low-carbing it at breakfast" thing, so I had thought oatmeal might be a good substitute.

It is not.

I explained, "I've been trying a different strategy pretty much every morning for the past week, without messing with my basal rates. Bolus early? High. Use an extended bolus? High. Up my insulin to carb ratio? High. Think about oatmeal? High."

"Maybe try something with some more protein? And let's increase your I:C ratio at breakfast, as well as inch up your basal rate a bit", she said, while I imagined her waving a magic wand.

And you know what? If improvement can be measured over just one day (it can't, but indulge me), she's right.

What's also encouraging is that my blood pressure measured lower than it has in years, my thyroid levels came back "perfect", my A1C result clocked in at a number my doctor and I were both pleased with, and I can't even get mad about gaining a few pounds since the last appointment because, hello, pregnant ladies do that.

I'm clutching to this moment where I feel full of win, and I'm running with it as far as it will let me go.

(Also, Baby Girl is moving around like crazy right now. She says "hi".) :)

Nobody Panic; The Coffee Is Safe.

A small list of things, because that's how I'm rolling today:

• Blog stats tell me that the search term "pictures of awesome" frequently brings people here. I do post a lot of Billy pictures (and may have tried to put glasses on him last night to see what would happen - he wasn't okay with it), so I guess that makes sense.
• The building I work in is going to be experiencing some construction for the next two months - actually, it will all be happening on my floor, specifically. They're building a wall and a new door (with a swipey badge thing - technical terms, people) to close off my area, but this also means that we won't be able to access our break room for that time. My first thought upon hearing this might have been, "But how will I get to the coffeemaker???" Rest assured - they're relocating that, too. We're safe.
• In pancreas-related news, I saw my doctor again last week. I didn't realize we were checking my A1C until she told me what the result was. Although it's higher than I want it to be (7.1), it is unchanged from last time - and I'm counting that as a good thing. I can be okay with consistency. Onward!
• I can't believe I'm thinking about Christmas already. WHAT.

I also saw something on Twitter about diabetes flash mobs? Color me intrigued. And blue. ;)

Ketchup.

No, not that kind.

I'm a fan of tying up loose ends. There are posts I've written here where I've said "...but that's for another post", or "more on that later", but then I never really go back and address whatever "it" was. I know that, as a d-blog reader myself, I appreciate when a storyline continues and updates are provided after something happens. I care about the people I read about, you know? I want to know what happens next!

So, in that spirit, this is a post where I attempt to catch up on some of those procrastinated topics.

• After writing Feeling Stab-y, I've decided that I need to try - just try, then decide if I want to switch to - using an automatic inserter for a pump site. Just to see what happens. I'd like to do this sometime in the next few months.
• New Hotness is working well (Sorry, Elle.) I did a 40-minute workout while watching House on Monday night that left me wondering, "Why am I not ALWAYS doing a workout while watching TV? That didn't suck as much as I expected it to!"
• I sneakily mentioned in this post my latest A1C result, which was a 6.9. I was pretty disappointed in myself, but it was a number that honestly didn't surprise me. Hearing it said out loud by my doctor, though, stung a bit. I know what I need to do to get back down to where I was, and I'm feeling motivated enough to get there again.
• I did order a new transmitter for my Dexcom, just in case. I also got Jim some new jackets - two of mine started tearing recently, so he's going to be all kinds of spiffy now.
• I STILL haven't downloaded my pump or Dexcom.
• I'd like to do another vlog, but seem to have run out of topics. If you have any suggestions, let me know!
• I've got a bottle and a half left of that creamer. Maybe I should have bought a dozen? Doesn't seem so crazy, now...
• This sinus infection put a kink in my intentions of half-marathon training. I've decided that I'm not going to try to run this one - that's not realistic for me, right now - but I can certainly walk it. Also, I use the word "training" loosely, because I am in no way organized or professional in my approach. An unlikely athlete, I am.
• And finally, in Deciding On Disclosure, I mentioned some "recent happenings" that I'm excited about. The biggest one of those is that I am going to be part of JDRF's Government Day event in Washington D.C. later this month. JDRF recently announced that it intends to expand its reach, support and focus to include the adult type 1 population, and as an adult type 1 myself, I couldn't be more excited about that. To that end, JDRF has invited a handful of adults with type 1 who are active in the DOC (diabetes online community) to participate in this event alongside some of their best advocates from each local chapter, and I am totally giddy about being included in that group! You can find some more information on the event here, and it looks like there will some live streaming of our blogger roundtable presentation, too, if you'd like to participate. (You can submit questions via Twitter and Facebook - look to the JDRF Advocacy blog for upcoming details on this.) You guys, I am so, so excited about this. And it's not just that I finally get to meet some of my favorite DOCers in person (YAY!) - I'm hoping this event not only helps JDRF find some ways to further engage with the adult type 1 community (because these two groups can do a lot for each other), and also helps us come up with some ways to reach those who haven't found our community yet.

So there you have it. Ketchup. Catch up. Whatever. :)

Diabetes (is not) Working for the Weekend.

Diabetes isn't very prominent on my radar on the weekends - and I'm not sure I want to change that.

It's part of the reason my A1C came back last week at a much higher 6.9, compared with the 5.8 I dominated with in November. (A lot of other things are to blame for that, as well.) But I think it also might be part of what helps me feel some balance with all of this super-regimented stuff I do during the week. After all, everybody "goes off the deep end" sometimes, and "needs a second chance". (Loverboy = lyrical geniuses?)

Monday through Friday, I'm getting up at the same time. I'm taking my pills at 6:12 each morning, pre-bolusing while I blowdry my hair, and eating breakfast - always an egg, Canadian bacon or turkey sausage with egg whites and organic provolone on a bagel thin, made by my awesome husband - on my way out the door.

I'm in one location for most of the day. Jim hangs out on my keyboard tray, and my testing stuff is sitting there, ready for me when I need it. I bring an easily-carb-counted lunch from home, and I go walking for 15 minutes twice a day, always at the same time.

On Saturdays and Sundays? HA! I dare you to find any kind of pattern.

I sleep late. I eat whatever, whenever. I SWAG bolus - a lot. I sometimes go hours without doing a blood test; relying heavily on my CGM for guidance. Weekend nights might find me with some wine in hand, or a Malibu and Diet Coke, or a shot of Patron. Or maybe more than one. A model diabetic, I am not.

Sometimes, too, I ignore Jim. Yesterday I helped throw a bridal shower for a good friend of mine, and my Dexcom receiver sat in my purse, in her laundry room, for three hours. I honestly didn't have the time or energy to feel badly about it either.

For me, it's helpful to have some time here and there where I do just the bare minimum. I test a few times throughout the day, take insulin, but try not to worry about much past that. I wish I could say that I'm okay with being super attentive to diabetes every single day, but the truth is that I'm not. It's mentally exhausting.

Some days you just want to pretend to be "normal" and not worry about dealing with all of this crap.

Didn't See That One Coming.

"And what are you here to see the doctor for today?", the nurse asked; her eyes remaining on the three-inch-deep pile of paperwork that is my medical file. 

It's a question that gets asked at every visit, even though I'm always there for the same reason.  "Oh, just the usual diabetes check-up, you know?"  I watched her scribble a few things down, and then she asked what medication I'm taking, which I always have to struggle to not laugh at.  "Well, it should all be the same as the last time.  Do you want me to list them all again?"  She shook her head.  More scribbling.

She checked my blood pressure - 126 over 76 - and we talked about pregnancy (hers in the past, and the one I'm hopeful for in the future).  She drew some blood.  She wished me luck, and left the exam room.  I relaxed, and waited.

The wait was so long that I began to wonder if they'd forgotten I was in there.  I Facebooked, I Twittered, I checked my blog stats.  I browsed the forums on Juvenation.  I considered reading an issue of People, but decided against it.  (Magazines in medical offices have to be some of the most germy things out there.)

Eventually, the door swung open, and my P.A., "D", walked in, smiling like usual - except this time, there was a little something behind that smile.

"Hi Kim!  How are you?"  We exchanged pleasantries, but she knows me well, and got to the point she knew I was anxiously waiting for.

"You know we checked your A1C today, right?", D said, with a bit of teasing in her voice.

"Yep!  How'd I do?" 

"Guess."

Oh, this game.  We do this every time.  Like always, I had brought all of my "reports" - the Dexcom data, two weeks of logs I had downloaded from my pump and meter, and my pump settings.  Jim's memories of the past two months led me to believe that I might have actually broken the 6.5 line, and I went a little bit gutsy with my response.  "6.3?"

Her smile broke into a grin.  "Nope.  Guess again."

I turned my head slightly and squinted at her; disbelieving.  "6.2?"

"Nuh-uh.  Guess again."  Her grin grew even wider, as did my eyes.  "What?  Seriously?  Okay, I can't guess anymore.  You'll just have to tell me."

There seemed to be an inaudible drumroll.  Then....  "5.8!"

My jaw hung open, and the corners of my mouth slowly turned up into a goofy grin.  I started laughing.  I didn't know what to do - but she did.  D wheeled over and showed me the proof, right there on the lab report. 

All I could do then was let out a single "Huh", and then, "Are you sure that's right?  I mean, I figured I'd be lower than last time, but... wow.  Wow!"  She assured me that it was, indeed, correct.

I don't remember what we really talked about the rest of the appointment.  I was in too much of a daze - first shock, and then amazement, and then realization - that I'd finally achieved that impossible dream I had of an A1C under 6.  I still can't really believe it, even as I'm typing this.  I know she asked me if I was having a lot of lows (I asked, "Um, define 'a lot'?"  We determined I was doing okay.), and she wrote me some new prescriptions.  She told me that she was proud of me, and of all of the hard work I'm doing.

My head was swimming with thoughts, with one treading water a little bit better than the others:  that's a great baby-building number.

On her way out, she chuckled.  "Well, I think I can guess what you'll be blogging about tonight!" 

She knows me well.

Six Things I Want You To Know About Diabetes.

Today is the Sixth Annual D-Blog Day, and the DOC is blogging about the Six Things We Want You To Know About Diabetes - so, here is my list.

1.  I don't expect you to know everything, or even most things, about diabetes.  What I do hope for is an open and curious mind, and your ability to patiently listen to me blather on about it.  I also hope that you'll retain at least some of what I'm saying, and pass it on to others who need to know.
2. "Sugar-Free" foods don't really do me any good.  All food (even protein) is eventually converted to glucose by the body, and even sugar-free foods still have carbs.  The sugar-free stuff doesn't taste as good, and I rather like to enjoy the food I eat - so hand me the real stuff, please.
3. Checking my blood sugar and inserting a new insulin pump or CGM site hurts.  It hurts every time, and I can't even tell you how many thousands of times I've stuck some sort of needle in myself during the past quarter century.  It's just a sort of hurt you get used to tolerating.
4. I am not my A1C.
5. But, when I have a "good" A1C, I will totally brag about it.
6. As much as diabetes can suck, it can also have an upside. As a side effect of our obstacles and challenges, I think we become stronger, more resilient, more compassionate, and more highly in tune with our bodies than most. Diabetes teaches us some tough lessons, but also makes us appreciate life a little bit more - because we recognize the fraility of it.

Meet-ups.

There's something delightful and familiar about meeting someone else with T1 for the first time.  On Saturday, I had the pleasure of meeting up with fellow T1 and erstwhile diabetes blogger Kay while she was in town for the football game.  My husband and I joined her and her friend downtown, as they were on their way to pick up their tickets. 

Is it just me, or are people with diabetes some of the most friendly and awesome people on earth? 

Kay and Kim.

We walked around UNL's campus for about an hour or so, and never ran out of things to talk about.  Kay brought up, and I totally agreed, that there always seems to be a sense of familiarity among T1's; even if you've just met, you feel as though you've known the person for some time.  There seems to be an undercurrent of understanding among us.

We talked about her insulin pump scare the day before; how others are never as excited about the straight line on our Dexcom graphs as we are; what our favorite flavor of glucose tabs are (fruit punch for me; grape for Kay); her meet-up with Lorraine in NY, and my meet-up with the TCOYD Des Moines folks in September.

We also discussed another point.  As I get to know more and more PWDs, I find that there is a segment of the population who seem to have it all "figured out" - or, at least they sure make it seem that way.  They do the same thing every day, and get the same results.  I asked Kay, "Is it like that for you?  Because most of the time, I feel like the numbers have the lead, and I'm just chasing after them, not the other way around.  I mean, everything works sometimes, but it's definitely not all the time."  It's as if my whole regimen has to be rehauled every few months, because what worked before just doesn't anymore.  While I am so happy for others who have an A1C significantly lower than mine, or who don't experience the fluctuations I do, some part of me feels a little bit left out.  Knowing that others deal with this too gives me some encouragement and motivation to keep at it.

It was a pleasure meeting you, Kay!  (And Go Big Red!)

Rules.

One of my friends on Twitter, Sarah, was having a rough morning, BG-wise and ketones-wise.  I sent her some reassurance, and the whole situation got me thinking that we need some ground rules on what to do when diabetes is being naughty.  We need to know what is allowed, and what is encouraged.  I came up with a few Diabetes Rules... That I Just Made Up.  Please feel free to add your own in the comments section.  :)

• You are allowed to yell at your blood glucose meter.  You can do this when you think it's wrong, when you don't like what it's telling you, or when it's Tuesday.  This is especially appropriate when that jerk tries to be all friendly and chipper, with a greeting like "HI".
• Calories consumed while overtreating a Holy Crap! Low do not count. 
• If your hand is shaking so badly due to hypoglycemia that you can’t hold a mirror still, maybe it’s a good day to skip mascara.
• Shutting down an annoying and inaccurate CGM receiver is totally legit.  I mean, that little guy probably needed a nap anyway.
• When you are at your endocrinologist's office, you need to have them celebrate your accomplishments with you.  A1C under 7?  High five.  Under 6.5?  Exploding fist bump.  Under 6?  Free puppy!
• When you hit 300 mg/dL, cursing is not only allowed, but encouraged.  I’m pretty sure it helps flush out ketones, too.

Relearning "Normal".

I am Kim’s Diabetes Paradigm Shift.

A large part of getting my A1C into range has been changing the way I think about, and react to, lows. The physiological and psychological effects of hypoglycemia are quite uncomfortable, if not a bit terrifying, to experience. This leads many of us to do whatever we can to avoid the feeling. As Henry Stewart put it in his series Insulin is Not a Cure, “hypoglycemia feels like a slow descent into death”.

For my readers without diabetes, allow me to give you some analogies of what severe hypoglycemia feels like.

1. Imagine yourself at your most hungry state. You haven’t eaten all day, and it’s now 9 p.m. You are ravenous, and feel like you could a horse.  And then maybe the barn he was in, too. Your brain and stomach are both in Full And Complete Panic Mode.
2. Think about a rollercoaster ride. The particular moment I want you to envision is the moment when you’ve reached the top of the first incline, and you start to see how far down you’re about to go. Think about the rush of adrenaline, how your body starts to shake a bit, and how you feel a little bit scared about what’s in store for you. Now, take out the fun part.
3. Now, for those of legal drinking age (because you’re all good boys and girls, right?), think about how you feel when you've overdone it. You lose a good deal of your motor skills, balance, and rational thinking. Also, again, take the fun part out.
4. Now, I want you to add in heart palpitations, a really bad case of the shakes, and a general feeling of helplessness. You can also add in “taste buds going numb”, or “feeling like you’re vibrating”.

So, to recap: You’re eating a horse, on a rollercoaster, while drunk.

Here’s the issue. Blood glucose has a very large range – you’re probably dead at 0 mg/dL, and you’re probably in DKA at 600 or so. The target area resides within a very small fraction of that range – 80 to 120, if I'm being strict. If I fall outside of that, I’m taking some sort of action: more or less insulin, or more food. That’s a very small range to shoot for, and when so many factors out of your control can influence the results, you can start to see how this disease can be a frustrating monster. You can also see how scary it can be to try to aim for 80, when a mere 30 points less than that has you wanting to crawl out of your own skin.

In the past, I was always trying to avoid going low, at whatever cost. If I ran a little too high, that was okay with me, because it was better than the alternative in the short term. But, priorities have shifted. I’ve got something I’ve been working towards being ready for, and this has required me to re-evaluate what my goals are.

Using a CGM has made all the difference for me. I talk a lot about why I love it, but I really can’t ever stress enough the difference it’s made in my life, diabetically speaking. To put it simply, my CGM is a safety net I can rely on while I walk the tightrope of glucose control.

I don’t have to fear a lot of things anymore.  Going low while sleeping is less of a concern, as Jim will do his best beeping and vibrating in order to wake me up.  While I may never have taken corrective insulin for a reading of 130 in the past, I feel comfortable doing that now, for the sole reason that I can see in almost-real time what will happen.  And I can feel confident when I walk to the other side of our neighborhood, because Jim will let me know if the exercise has caused me to bottom out.  I don't have to wait until I feel the lows anymore.  I can take pre-emptive measures.

A reading of 80 mg/dL doesn't seem "low" to me anymore, and it turns out that, for me, a fasting blood sugar of 65 doesn't need to be treated.  If I can force myself to just wait it out (which I usually can, lately), I have learned that the mere act of waking up will cause my glucose level to rise about 20 points - which puts me right back in range.

This is a whole new world for me.  Trying to change two decades' worth of viewpoint is hard, and anything but easy.  I'm retraining my diabetes brain.  I'm still not "perfect", but I tend to question anyone with diabetes who claims to have "perfect" control.  Diabetes is a fickle monster, but it's not the whole picture of your health.  I'll do what I've always done, which is to do the best I can.  It's all any of us can do.

Victory Is Mine!

Today was the Big Day.

At least, to me, every time I get my A1C checked, it's a Big Day.

As I've discussed before, I have mixed feelings about the amount of importance we place on A1C results as the sole indicator of control.  I've worked so, so hard on keeping my numbers as close to "normal" as I could in the last three months, but I know that my A1C doesn't mean I was "good" or "bad" - it's supposed to be viewed as just another number to help me determine which way to go from here.  However, I still can't keep myself from feeling like I'm getting a report card - and when I get a report card this great, I can't help but show it off to a few friends.  (That's you!)

6.5!

This is huge!  For those unfamiliar with A1C testing, here is a brief explanation, courtesy of the CDC's website:

[An A1C test is] A test that sums up how much glucose has been sticking to part of the hemoglobin during the past 3–4 months. Hemoglobin is a substance in the red blood cells that supplies oxygen to the cells of the body. The AIC goal for patients in general is an AIC goal of less than 7%. The AIC goal for the individual patient is an AIC as close to 6% as possible without a considerable amount of low blood glucose.

So, I'm finally in range.  I haven't had an A1C this low in a long, long time.  In fact, my P.A. printed off for me every A1C I've had while in their care, and they've usually been in the lower 8's.  In April, I had a 7.1, which I thought was GREAT - and now, I've graduated to the 6's.  It's a great feeling.  You know what else is a great feeling?  Getting high fives, congratulations, and "We're proud of you!"s from your medical team.  :)

My Insulin Pump Story, Part One: How A Tiny Robot Threatened My Mad Ninja Skillz.

I orginally intended to do one long post about my process of accepting an insulin pump into my life, and how I wear it.  But, like usual, that got me going on other semi-related points, and before I knew it, it was going to be a small novel...  soooo...  I'm breaking it into two parts, spread out over two days.  You're welcome.

******************************************************************

Prior to actually wearing one, insulin pumping was never something I was all that, er, "pumped" about.  (HA! I love D-humor.)   

The idea of me actually wearing an insulin pump was first brought up to me in 2004, by a new endocrinologist I started seeing (Doctor B).  He was all about technology, and I was very comfortable with my injections, thank you.  Even making the move to insulin pens from syringes and vials had taken some coaxing.  I mean – this would be a big step.  And one I didn’t feel prepared to take.  The only times I’d seen someone wearing one, they had it clipped to the outside of the waist of their pants, and I really didn’t like how that looked.  Not very subtle, right?  I dreaded the idea of having to have it “on display” all the time.

As I’ve said before, sometimes I like to be discreet about my D.  A diabetic ninja, if you will.  I don’t necessarily want my robot parts to be the first thing someone notices about me – I’d like to have the say-so in who knows and when, in some situations.  Job interviews, or meeting new people for the first time, for example.

Another reason I had for putting off getting a pump was dating.  It sounds ludicrous to me now, but I thought any guy who saw that a machine was attached to me at all times (albeit, a small, life-saving machine) would be turned off.  I was scared that no one would want to date me while I was wearing that thing.  I made a deal with myself that once I was in a stable relationship, I’d give the insulin pump idea another look – but not until then.  I really wasn't giving myself enough credit - or looking at it from a logical standpoint.  Because, really:  anyone who doesn't want to date you solely based on the fact that you wear a piece of equipment that helps you stay healthy isn't worth dating in the first place.  Would I really want to be with someone like that for the long haul?  Would I really want to live the rest of my life with someone who values appearance over health?  That would be a long, hard road to walk with someone.

Destiny spoke in 2005.  I started dating my now-husband, A, in January of that year, and our relationship might be the only good thing to ever come out of MySpace.  I was browsing through my friends' friends one day, and came across a picture of a guy with a huge beard who was playing bass guitar (and seemed to be having a lot of fun doing so).  I thought "Hey, this guy looks like fun.  And he's cute.  And he plays guitar.  Friend request!"  A and I chatted online for a week or so, and got along really well.  He invited me to come see his band play, I did, and we were inseperable from pretty much that moment on.  He has an infallible knack for getting me to burst into giggles, he's the most patient and easy-going person I've probably ever met, and he gives one heck of a great hug.  How could you not love this man?

By the end of that first year, I finally started thinking that an insulin pump might be kind-of okayish.  I knew that my A1C needed improvement (I had been consistently hanging out in the 8's and 9's), and I was told that a pump could help me with that.  I still didn't like the idea of being attached to something at all times, but I knew the benefits would probably outweigh the inconveniences.  On a few occasions, I’d brought up the idea to A, and he always said that “If it means you’ll be healthier, I think you should do it”.  (That's how you know you have a keeper!) 

I worried about what others would think of it.  Would I get stares?  Would people even know I was wearing one?  Was I being too paranoid about this?  (In most cases, the answer to that last question is "yes" for me, but I still think it's a valid concern.)  I didn't have anyone else to talk to at the time, to ask real-life questions of.  Having someone like that to talk to probably would have coaxed me into trying an insulin pump sooner, but that's just how it went.  I finally caved, my doctor did the footwork required, and I had my Deltec Cozmo insulin pump.

My next issue was... where the heck do I wear this thing?

I Guess This Is What My High School Math Teacher Was Talking About.

As a diabetic, and especially as a T1, my life is ruled by math - but really, just numbers in general. Keeping track of everything (glucose readings, insulin doses, food consumed, exercise, stress, etc.) was extremely overwhelming before I had an insulin pump and CGM to help record and remind me of some of my numbers.  I am also lucky, in that the "math" part of my health care can usually be done by my insulin pump.  However, in those rare moments that a pump malfunctions, I need to know the equations necessary to keep my insulin doses in check. 

In the diabetes world, numbers are often viewed as a gauge of how well you've been taking care of yourself – except, are they? Here’s a look at the D-numbers that make an appearance in my daily life.

1. 15 to 25 – the amount of blood tests (pricking my finger) I do each day
2. 13 – the number of different basal rates* I have throughout the day
3. 1:5 – my insulin to carbohydrate ratio at lunch time (there are different ratios for other times of day)
4. 15 – the minimum amount of minutes I need to wait between taking insulin for food, and actually getting to eat it
5. 1:20 over 100 – the correction factor I use when figuring out how much insulin to take for a high glucose reading
6. $732.56 - the amount of money Walgreens says my insurance saved me - on ONE MONTH'S worth of test strips
7. 5 - the frequency, in minutes, that my CGM (continuous glucose monitor) checks my blood sugar
8. 140 – my 30-day blood glucose average, according to my glucose meter
9. 7.1 – my last A1C result

Some of these numbers have a lot going on in the background. Take number 5, for example – my correction factor. If I do a blood test and see 225, that’s definitely out of range (which, for me, I consider 80 – 120). But, I have to think about why I might be at that number – did I count the carbs exactly right in the food I ate? When WAS the last time I ate? Was I higher than this previously, and I’m actually mid-drop? Is my insulin pump actually delivering insulin, or did the cannula get clogged? Am I feeling especially stressed? All of these factors could have played a part.

Then, there’s the last item on the list – my A1C result from April. (The full name for the test is a Hemoglobin A1C test, which is a indication of your average blood glucose levels over the past 3-ish months. The recommended range is 4 – 7.  To put this in perspective, a 6 correlates to an average BG number of about 122.) I have been working very, very hard to bring my A1C down. Previous to this last test, I had pretty consistently come in at the 8 – 9 range. 7.1 was huge for me.

However, I can’t help but feel that A1C testing, in general, is flawed. So much rides on this one number. For most, it feels like a report card for “how well” you’ve done managing your diabetes, and is the benchmark for most of the medical community. Bad A1C?  You must not be working hard enough!

To some extent, this can be true - but not for every case, and not for every person.  An A1C result is only an average. This means that someone who consistently had a BG of 122, which mild or no fluctuation, has the same A1C result as someone who pings between 50 and 200 all the time – and the fluctuations are dangerous. 

The logical side of myself knows that the numbers are meant as tools to help – not as a measurement of whether I am a "good diabetic" or "bad diabetic". But, I often can’t bring myself to get past the feeling that they are just that - grades.  I want the numbers to reflect how hard I’m working, and they just don’t always do that. Some days feel like I’m fighting a war I can’t ever win. But, I just have to learn from the experience, and come out swinging - ready for the next battle.

*For those who are unfamiliar, a basal rate (not to be confused with "basil" - which would be much more delicious than insulin) is the rate of a continuous supply of insulin, provided by an insulin pump.  Different activities and times of day require different amounts of insulin, in order to maintain steady blood glucose levels.  What kinds of things can affect your blood glucose level?  That's for another day, and another post.  :)

Sugar Stalking.

A typical definition of stalking includes "a series of actions that puts a person in fear for their safety".  In my case, my series of actions - up to 22 finger sticks per day, and an almost compulsive need to check my CGM screen - have quite the opposite goal. 

In January of this year, I got my Dexcom continuous glucose monitor.  It comprises one of my two "robot parts" (the other being my Animas Ping insulin pump), and I love it.  I've learned so much about how different foods affect me, which has helped me to more efficiently use my insulin pump, as well.  I can know what my numbers are doing while I'm exercising, and catch lows that I might not otherwise feel before things get crazy.  And, even though I hate the loud BEEEP!  BEEEP!  BEEEP! when I'm trying to sleep in the middle of the night, I appreciate that someone - even a robot - is looking out for me when I fall dangerously low.

The flipside of all of these wonderful things is, I've become a little crazy.  Okay - a lot crazy.  Obsessive is a more accurate term.  Being able to know where I am at all times, and then learning that the CGM isn't always reading accurately, has caused me to more than triple the amount of finger sticks I used to do.  I'm a person who is all about the details, and I want to know.  I need to know!  I'm trying to bring down my A1C, and I can honestly say I've never been so motivated in my adult life to gain tighter control of my numbers.  It's scary, frustrating, and exciting all at the same time.  My last A1C, which was in April, was a 7.1... and my goal for July is 6.5.  We'll see!