This is a guest post submitted by Lorraine who is doing an excellent job managing her son’s (Caleb) type 1 diabetes.  I met Lorraine through twitter, which is an excellent medium to talk real-life diabetes.  From our first few conversations, I knew that she was doing a lot of things right for Caleb and keeping his A1c numbers near perfect.

I want to thank Lorraine for sharing her story and tips to help manage type 1 diabetes.  Thank you Lorraine and keep up the great work!  Caleb may be too young to understand, but someday he will thank you for all the hard work you put in to help him live a better/longer life.

* * * * *

Managing Caleb’s blood sugar, from a self-admitted neurotic mom

Background:

My son Caleb was diagnosed almost 2 and a half years ago at the age of 3 (almost 4). With so few non-D years behind him, and so many D years in front of him, I have made it my mission to bank as many years as I can with near-normal A1Cs in hopes to minimize those ugly complications when he is older. Caleb has been pumping for just over 2 years, since about 3 months after he was diagnosed. I never set out to achieve a certain A1C.  All I know is I do whatever I can to keep his blood sugars in range.  I am often unsuccessful.  But lots of the time we achieve what we want to. I have never been given any specific guidance on targets or acceptable ranges.  Caleb’s Endocrinologist has always reviewed his results and found them acceptable and not mentioned what precisely they “should” be.

Guiding Principles:

1. I check Caleb’s blood sugar about 12 times a day, including overnight.  Sometimes less, sometimes more.  I check, assess and act.  
2. Everything he eats, I weigh and measure whenever I am able.
3. I do not limit what or how much Caleb eats.  I manage it, but I do not limit it.  There are foods I prefer to stay away from, but I won’t ever tell him he can’t have something because he has diabetes.  Even at school and birthday parties, he eats what the others do.  It usually means 100 plus carbs for a snack and a few extra BG checks, but he smiles as he shoves the cupcake and other junk in his face and that makes me smile.  Everything in moderation – that goes for him and my other, non-D kids.
4. Caleb typically eats 3 meals and 2 snacks a day.  That frequency allows me to be a little aggressive on dosing when I have unknown carb counts.  If I have an uncertainty, I will check and hour and a half after a bolus and if it’s lower than I think it should be, it’s usually around snack time and I can just decrease the bolus of what he eats to mitigate that low without disruption to his schedule.  
5. Caleb seems to go through “waves”.  His insulin needs creep up, up, up….plateau, and then go down, down, down…plateau, and over and over again.  Perhaps all diabetics are like this.  I attribute the waves to growth, but who knows.  In order to keep up with the waves and still keep his sugars in range without constant corrections, I track all his dosing and stats in a spreadsheet.  I used this religiously for months.  As I have learned from it and things have become more predictable, I do not use it as much – only in periods of lots of unexplained BGs.
6. I keep a pretty close pulse on his basal rates.  If there’s a low or high 2 days in a row and I am confident that food is not an issue, I will adjust basal rates.  I know that .05 will have about a 30 point impact on his BG.  
7. Food – Pizza, Ice Cream, Chinese, Bagels, Pasta, anything fried – they all break the rules.  I have charted Caleb’s BG’s for months when he eats these foods and have been able to develop specific extended bolus’ for each.  I keep them in my spreadsheet and in my cell phone.  I continue to tweak them since things are ever-changing, but I at least have a baseline and don’t have to completely freak out when we indulge.
8. Super Bolus.  Of course there are occasions when that nasty 300 pops up.  I don’t mess around.  I find John Walsh’s Super Bolus to be very effective: bolus the calculated correction plus the amount of basal to be delivered for the next two hours.  Then turn off basal for the next two hours.  This front loads the insulin to bring the BG down fast, but prevents bottoming out since the basal is turned off.  This has been particularly useful when we are about to eat a meal that would be awkward to delay (like at a party).  But I am careful with this at nighttime – not quite as aggressive.  For Caleb, I find I need to add a little insulin for those high highs – his normal correction factor needs a turbo charge to tackle those numbers – but of course YDMV.

Those are the highlights.  I’ve been thinking about this as we go through our days to make sure I have everything covered.  I think a big thing is keeping on top of things at night, particularly since that’s about 10 or 11 hours for Caleb.  I check a minimum of two times while he sleeps, but in times of change or when he eats a challenging food, I will check more.  And if a correction is needed, I will always check 2 hours after no matter what.

* * * * *

One thing that quickly jumps out at me is the care and effort Lorraine puts in to managing Caleb’s diabetes.  She doesn’t just check and react.  There is much more planning, trending and analysis put into his diabetes management than I would expect most diabetics put in, me included.  The theme here is to not be complacent and just wing it.

If you are interested in providing a guest post, please contact me for more information.