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The Joslin Aftermath.

Our appointment at Joslin this past Friday was a much better one.  Hard work is paying off, and even with Barcelona smack-dab in the middle of my August, my numbers were much, much better.  And that made me grin.

Chris and I met with a certified diabetes educator at Joslin and while reviewing my spreadsheets (hat tip to Kevin, who is currently my diabetes hero), she noticed that my morning blood sugars were a little elevated. 

"Mornings are good, but you have a trend of the last few weeks at around 120 mg/dl.  For pre-pregnancy, we want you 100 mg/dl or under."  But then she grinned.  "But not too under that."   

My basal rates right now are higher in the morning from 6:30 am to about 11 am, with an extra kick between 6:30 and 8:00 am.   The CDE suggested that I just extend the "kick" and keep my morning basal elevated through the 11 am marker.  But I didn't agree entirely.

"I'm afraid I'll go low.  I don't think I need that much insulin at 6:00 am."

"Well these elevations are a trend, so it could be a good idea."

(Note:  It's so, so, so weird to think of 120 as "elevated."  I know this is the mindset I need for pregnancy preparation, but it's still disconcerting to look at a blood sugar of 120 and think, "F.  I need to correct that."  /Note)

So I changed my basal rate reflect her suggestions.

And spent the next three mornings waking up low.  The Dexcom was freaking out around 6 am every morning, blaring its alarm.  And when I'd test, I'd see 50 mg/dl almost like clockwork.  Glucose tabs were part of my morning routine before I brushed my teeth - not okay with me.  So I made a different basal tweak a bit later in the morning to help lower that 120 mg/dl - and to help stave off the lows.

This whole boring story (stop snoring and wake up - I promise this post has a point) is to illustrate the fact that even though certified diabetes educators have a pile of education, experience, and compassion, they are only part of our diabetes management team.  The endocrinologist, the CDE, the nutritionist ... the list goes on and on and they're all so helpful, but it all comes back to US.  We get what - fifteen minutes of their time every few months?  Diabetes is our disease every day, and even though we touch base with our doctors every few months and have their guidance, we manage this disease on our own.  We aren't jusWould you fear a bear eating Wheaties?  I would.t diabetic at the doctor's office.  We know our bodies best and we are our own best caregivers.

Joslin kicks arse.  That's without question.  And when Chris and I are ready to be parents, they'll take great care of us and our baby.   But The Sparlings kick quite a bit of arse, too.  And I have full confidence that we're going to be able to conquer these blood sugar issues and get things more and more in line.

There.  My Monday soapbox.  I'm going to instill the fear of bear in my diabetes.  (Or at least the fear of Rocco.  That thing had to be a sign for something.)

Comments

wow mini wheats send my bgs soaring and then the rest of the day is shot and I am not worth much LOL !!!

Kerri-
KEEP UP THE GREAT WORK!!
Kelly K

Awesome post. And so true. Loved the picture by the way!

I am so excited for you! It was thinking about pregnancy (a long, long time from now) that I had my "D awakening" so to speak - and being able to watch you be successful in the beginning of your journey (and hopefully more) through dblogging really encourages me for the future. Thank you so much Ker!

Very cool and good work. All you are doing makes me so proud of you. You are gonna be such great parents. Heck you already are!

Keep up the great work.

I've told my Endo in the past, "No. That won't work."

Only we know ourselves and what will work. Guidance is only part of the whole equation....

I have just read your grocery wars post - oh so true and oh so funny! As a mum with almost 2 years experience of a child with diabetes(not long I know) I have to agree that sometimes we know best. Guidance from the clinic is important and not to be under rated but sometimes you have to go with your gut instinct as to what is right. Sounds as though you and Chris are on track. Keep up those spreadsheets! :)

Yo Amanda!

Two years with a T1 kid qualifies as a veteran!

It is long. I know.

To that I'll add my all time favorite D quote;
"My wife and I are our daughter’s primary care team.” - Mark a dad at CWD's FFL

Love your blog...boy can I relate!!

I'm also in the pre-preggo boat with you, although I'm in the "actively trying" stage. Very exciting, yet very scary at the same time. Visit my endo tomorrow. Hopefully a1c is cooperating!

Gotta love the 120 "highs"...who would've thought!

Keep up the great work!

I could not agree more. My diabetes educator fussed at me for drinking juice when my sugar was 62 because 60-90 is considered a normal fasting rate for pregnancy. I told her I knew it was on the way down and she just looked at me like "how could you know?" but I could just feel it.

They have a lot of book knowledge but nothing beats our instincts.

Any average of 120 seems pretty damn good, even when pg. :-) I usually woke up at 65-90 during both of my pregnancies and yes, a lot of 50s. Thank goodness though, made up for the rest of the day with lots of numbers over 120 that come along with the challenges of actually *eating*. Thank goodness pregnancy is only 9 months! (Or wait: more like a year and a half with D!)

(going on 23 years with T1)

Hi Kerry,

I've been reading your blog for some time now, and found encouragement and useful info.
I was diagnosed with D1 just a few months ago and I'm on honeymoon since then.

Too many things for a brain to handle, but your blog has really helped me.
Your humour too!

Thanx and good luck with your pregnancy plans (I am having some myself!)!

Diabatissa

Great work! I remember a doctor saying something once about how a diabetic would just do what they want anyway...and it was said in a grudging or sarcastic way...but I remember thinking, well um. But that just doesn't seem right to me. If I do that, this is going to happen. :D Still, giving it the old college try validates their efforts, so I do that. I try to remember, they are PRACTICING. I'm LIVING. :P Have a great week.

Below 120, you got to be kidding. When I hear stuff like that I question the person telling me it. These people are not always right. But it is a baby issue, I still think it's crazy.

After my third low, I would have been so upset that the next time I seen this person, they would have been a boot puppet.

Good luck with that, I got faith in you, but man, that is a scary goal.

I wish you well

Robert

Good luck with the getting pregnant part, but just know - 100 is great and where you should be but 120 isn't an "F". The first pregnancy is SOOOO much easier than any subsequent ones, but all of them make you beat yourself up! I had a 5.4 AIC with my first pregnancy and he still came out with low blood sugar and was in the NICU area for a while. But he is great and a 6 year old in Kindergarten now! It will all be good.

Awesome!!! Too cool! Yeppie:) you'll be a good MOM!

No hero here... just a data dork. (I had just gotten Little Feat's "Time Loves a Hero" out of my head last week... seems it's back now. Thanks a lot, Kerri!).

Keep up the good work!

PS: For all your happy reader who's logbook requests I've been filling lately (which has been a lot!): I'll be heading out of town tomorrow to go to the Whitefish, MT JDRF ride, so I'll get back to you when I get back!

You know though, it's possible that the Joslin team is right on on this one, Kerri. I'm four months pregnant, so I've had similar goals since pre-pregnancy and am now actually comfortable waking up most mornings at 65-70 mg/dL. As soon as I drink my (one precious) morning cup of coffee, I spike up to 80 or 90, bolus for, wait, and enjoy breakfast, and no longer deal with the scary morning insulin resistance that lasts through lunch. My Navigator has me sitting at a perfect 100 right now an hour and a half after eating.

Is it possible that you could safely reset your personal threshold for what's "low." I still TREAT a reading in the 60s, but I am way more functional there now that my average is in the 110s.

MelissaBL - I hear you. :) I've been lowering my tolerance for lows and now I can hang out at 70 without feeling nervous. (That wasn't an easy journey, believe me!) But as far as Joslin went, they were CLOSE to right. I needed a basal tweak, but not one that was so intense so early in the morning. Instead, I changed my basal to their recommendation and started it an hour later than they had suggested, which has left me in the under 100 range for the last two days but without the serious lows at 5:30 am. :)

Tweak, tweak, tweak until I get there, right? :D

And congrats on your pregnancy!!! That is so exciting!!!

Hey Kerri-
I definitely corrected when I was at 120. My endo wanted me around 70 when I woke up in the morning. I'm sure that could explain why my A1c was 5.2% when I was pregnant! It's a little weird to correct when you're at a number that is thought to be "normal" but I learned to just take .2 or so units to correct and I was good. I'm really glad to hear that things are going well for you! I wish you and Chris the best of luck. The whole process is exciting!

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