Thursday, May 9, 2013

5.5: The Holy Grail of BGLs

Apparently in the world of D there is an ideal number that all diabetics want to see on their meter. This number is so sought after that there is an entire Facebook group dedicated to people posting photos of their meters displaying this number. The group is called The 5.5 or 99 Club, so called because 5.5 mmol/l (or 99 mg/dl if you're American) is that much desired number.

Well, guess what? We got our first 5.5 today. Yes, here's proof:

I do actually get excited about this sort of thing. Chief has spent so much of the last 6 months with readings in double figures that I simply love seeing 5s, 6s and 7s on her meter. And well, I really didn't think I'd see a 5.5 until she had her pump (yes, yes, more on that later, I promise).

This beautiful photo of the perfect number belies the morning we had getting her there, however. I would love to say "it started off as any other ordinary day" but it didn't because last night we had pasta. Pasta, the one thing, other than eggs, that everyone in the house eagerly demolishes in silence, and it is a scourge on the levels of a Type 1 Diabetic. Sad, but true. (Yet another motivation for getting a pump: the combo bolus! Yes I realise I am speaking double dutch. All will become apparent in due course. Just not today.)

So last night we had pasta, and rather than give her all her insulin at once and have her hypo after dinner, as is usual, or delaying her insulin and having her go hyper after dinner, or end up having to give her two needles, which nearly always happens with pasta because she always goes high later in the night, regardless of whether she's gone low after dinner or not. Rather than all that we tried a new tactic, based upon the advice of a very knowledgeable friend. This friend slightly reduces the rapid insulin (to avoid a hypo) and slightly increases the long-acting insulin. Previously we haven't been game to do this as we didn't give Chief any long-acting at night but as she is emerging from honeymoon (i.e. producing little to no insulin) we have been playing around with long-acting insulin at night and felt more confident in doing this.

Apologies for getting technical. To cut a long story short, there was no hypo, then a not unsubstantial rise later at night, followed by a slight drop before breakfast. But she still woke a bit high and needed extra insulin to bring her back down. She also had low GI porridge for breakfast. A ton of it. And fruit. That girl could eat more breakfast than a sumo wrestler. I gave her 8 units of rapid insulin for breakfast (yum!), which I think is a lot. Occasionally she might get 6 or 7 but usually it's around 4 or 5. I don't think I've ever given her as much as 8.

More than 2 hours later I tested her at morning tea time as I dropped her off at daycare. She was very high, around 20mmol/l. I knew she still had active insulin, but probably also had active carbs. Her morning tea also contained carbs so I had to do a quick calculation and rethink and completely change her daycare meal and insulin plan. It was slightly stressful as I had to replan and then instruct someone else on how to manage her, and I wasn't sure whether I should be taking her home and monitoring her there. Anyway, I calculated that she had almost 3 units of insulin left in her system and that she might end up crashing down but by then it would probably be lunchtime and she could just eat lunch. I checked her again half an hour later after I'd settled Happy in his room and done my calculations, quickly swapped her very low carb afternoon tea for her morning tea so she could eat with her friends and instructed the teachers to call me after each test for the rest of the day.

The next test was when we got this beautiful number. I could have jumped for joy. A few months ago I would surely have stuffed this up and ended up with high numbers all day. Her teachers are much more confident now too, which helps matters immensely. She had her usual food and insulin at lunchtime and at afternoon tea took an extra needle to cover the extra carbs.

This is by no means a typical day. Most days the same thing happens and it's all reasonably predictable. But this is fairly typical of the kind of curve balls diabetes throws at us and how we need to be able to think on our feet and be constantly mentally aware. This is why us D-parents are always so exhausted, drink lots of coffee and are incapable of holding a normal conversation. Just so you know.

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