Friday, November 04, 2005

A Numbers Game

Diabetes is the ultimate numbers game, where your very life is at stake...not money. (Well, money, too. Diabetes is an expensive disease, after all.)

Of course, there are the number of units of insulin you are taking. For pump users, that includes basal rates. It involves carefully working out the exact correction factor and carb-to-insulin ratio. For me, we're talking 1 unit for every 30 mg/dL over my target BGL, and 1 unit for every 9.5 grams of carbs.

Next up, we have carbs. Counting carbs. Often, it is guessing carbs. No, scratch that. "Estimating" carbs. We never guess. Right? That pile of rice on your plate? Well...it is somewhere between 10 and 100 carbs. I'm sure of it.

Then, the all powerful blood glucose level (BGL). This is where the numbers game turns into a gambling addiction. We obsess over the BGL, always hoping, praying, that after that 5, 4, 3, 2, 1 countdown, we see the perfect 98 mg/dL! (Or, whatever your preferred target value is.) It rarely happens. And when it does, we are totally shocked and test again just to make sure it wasn't a fluke. More often than not, we lose the game there. But, we can't stop playing. So, we try again.

Beyond that, we move into more esoteric territory. Numbers we can't directly see nor control. A1c. The payoff of every diabetic's gambling. The doctor wants it below 7. We rejoice when we just manage to pull a lower A1c than we did three months ago. Finally, after years of trying, I finally managed a 6.7! Time to celebrate, right? But then my doctor informs me that they now want everyone to be below 6.5. Argh. Just when you think you hit the jackpot, they change the rules on you!

Throw in your weight, cholesterol levels, microalbumin count, and the number of hairs on your head (okay...maybe not, but sometimes it feels that way), and you can see the problem. The game is rigged, I tell you.

But, there is no choice in the matter. We can't opt out of the game. So, make the best of it. Have fun with the game. And really focus on the nuances that are important.

Let me tell you a little secret about BGL. It doesn't really matter if it goes high. Hit a 300? Don't fret. Your A1c isn't shot because of it. You won't suddenly develop retinopathy. The key to success isn't in that single number. It is keeping your BGLs from staying high.

You test. You see that 300 and panick. But then you correct. An hour later, you are at 150. Another hour later, you are at 120. No harm done. It is when you see that 300 and do nothing that is a problem. You leave that 300 there for several hours, and you are going to have issues.

In gambling...or, perhaps, the stock market is a better analogy...it doesn't matter that you just lost $500 today. Not when you have made $2000 in the past month. We are in this thing for the long haul. Always remember that!

1 comment:

Martha O'Connor said...

Inspiring post, Ryan. Thanks...