So, what have I learned since then? Plenty. So, I thought I would share some key lessons for those of you with diabetes, or with children with diabetes, or with friends who have children who have friends that have mothers who have siblings who have children with diabetes.
- Don't trust your doctor. Not that I'm saying you should ignore them or anything. But I've learned that despite most endocronologists being an "expert" in the field, they really don't know what it is like to live with diabetes on a daily basis. I've even dealt with a few that had God-complexes, insisting that I consult them for each and every change I make. Sorry, but I don't have time for that. I will add the caveat, however, that in order to really take responsibility for your own diabetes, you need to be well-educated. There is much to learn...so make the effort to learn it! Not only will you be able to control your diabetes much better, it will make the workload of your endo significantly less.
- Learn your symptoms...but test anyway. I will admit that I can, usually, tell my BGL to within 50 pts (mg/dL) without every poking a finger. I know my symptoms, and I'm keenly aware of them. And I've experienced them all. Blurred vision (low), moodiness (high), frequent urination (high...or, perhaps, the result of that Diet. Mt. Dew I just had), weakness (low), a sticky taste in my mouth (high), inability to concentrate (low), frequent coughing (borderline high), etc. But, no matter how well I can detect my BGL...usually...there are those times I don't. So, test. Take note of how you feel when your BGL is slightly high, slightly low, very high, and very low. Remember how you feel, and next time you feel that again...test!
- Analyze, analyze, analyze. This ties to number 1. But it is important to pay attention to all the variables in your life that affect your BGL.
Number one, of course, is carbs. I spent a long time tweaking my insulin to carb ratios.
Number two is basal rates (if you are on a pump). Even before I was pumping, I threw traditional therapy to the wind and went to a three-dose-a-day NPH schedule in order to simulate a better basal rate. When I switched to Lantus, I used two shots a day rather than one. My endo thought the idea was odd...but a year later, he ended up finding a colleague who was doing that very thing with his patients with much success. On a pump, you need to spend a lot of time and effort getting your basal rates correct for a fasting diet.
Number three, correction factors. Take advantage of your highs. Bolus, and check, then check again. Pay attention to how much insulin it takes to bring your high down. If you are 300, and you give 4 units, and three hours later you are at 200, then you know each unit lowered it 25 pts. There are exceptions, however. I have found that if I'm high not long after a meal, or if I'm feeling particularly full (loss of appetite), that I still have more carbs in my system that haven't yet been digested. So, I might give those 4 units, and find that it doesn't do anything. All I'm doing is giving my body enough insulin to keep the BGL from going yet higher. Watch out for over-correcting. Then you start yourself on that roller coaster ride.
Speaking of roller coaster rides, watch out for "feeding" your lows as well. If I wake up low, I feel ravished. I'll eat everything in the kitchen until my BGL is up. So, at those times, rather than trying to force myself to only eat enough to bring up my BGL, I actually will eat a lot of carbs. But then I bolus. Strange to do, I know, when I'm low. But if I am at 50, and I really only need 10 carbs, but I end up eating 60 carbs...then I need to correct for those 50 extra carbs. (Though, I will generally be careful, and give myself an extra 10 carbs leeway.) So, I bolus for 40 carbs, and allow the other 20 to raise my BGL. This keeps me off the roller coaster.
- Watch for the unknowns. This is being mindful of those unexplained highs and lows. Just because you can't explain them doesn't mean there isn't an explanation. For example, I found out that Little Caesar's Deep Dish pizza will cause a huge BGL rise about three hours later. (The dreaded "pizza effect".) Now I know to give myself an extra extended bolus for pizza to counteract this. I might not know the reason, fully, but I can recognize the pattern and prevent it. Also, I know that high-fat foods cause a temporary insulin resistance, which might wreak havoc on your insulin-to-carb ratios. Protein, as well, can eventually turn to carbs in the body if you consume enough. Take note of each time you experience any unknown...and then go back and see if you can figure out any pattern. You might even try reproducing the events. Eat the same meal, for example, a few days later and see what happens.
And take a moment to share something you've learned!