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When In Doubt, Look to Kevin.

Last week, I met with a new primary care physician, and as part of the "getting to know you" groundwork, she ordered a full lab work up, including an A1C.  And I felt pretty good about it, because I've tried really hard to leave the gross bout with diabetes burnout behind, moving forward with a better mental attitude about the whole thing.

"So you're feeling all sunshiny.  That's great for you, but a good mood doesn't lower your A1C," says the grumpy voice in my head. 

Right.  Which is why shaking off the burnout included letting go of the guilt, but also ditching the bad habits and making a focused effort to make sense of my diabetes management.  

I've tuned back in to my Dexcom, and am making the most of the information it's throwing my way (like correcting those subtle highs of 170 mg/dL, instead of letting them linger). I'm testing my blood sugar way more often (back up to about ten times per day), and while the average on my meter isn't anything to write home about (151 mg/dL), I'm really working to bring that number down without an onslaught of low blood sugars. I don't know ... I feel better, overall, and more confident in how I'm managing my diabetes these days.

So when the nurse called me yesterday with some labwork results, I was really, really disappointed to hear that my A1C was not reflective of the work I've been putting in.  It's lower than it was a few months ago - a major plus - but not close to where I want it. And that frustrates the hell out of me, because I want that number to reflect effort. The A1C value is what we're judged on, as PWDs. That number is what healthcare professionals ask us about, and base their judgment of our diabetes control - sometimes of us, personally - upon. 

When the nurse told the result, I let out a low whistle and admitted, "I thought it was going to be a bit better than that."

"It's higher than we'd like you at," she said, without a trace of judgment in her voice. 

And I wanted to tell her that I have been testing a lot and reacting to the Dexcom and working out and trying to eat better and with more regularity ... I wanted to give her that deluge of information, because I didn't want her to think I was okay with That Number. I was new to her practice, and I wanted her to know that these labwork results matter a whole lot to me, that I was working diligently towards better control, and I wanted to be a patient they wanted to work with.

But all I said was, "It's higher then I'd like, too. But I'm working to bring it down."

Life gets in the way of good diabetes management. When I was trying to get pregnant and then during my pregnancy, I spent the majority of my day stalking diabetes. I tested a ton, wore the Dex, logged my blood sugars, and didn't do much other than that. My A1C was gorgeous (6.3 %), and my job was to create a safe environment for my growing baby. Incentive, at that moment, was the Birdy.

Now, I'm not in a position to dedicate my entire day to diabetes management. It's that whole "Life" thing again. The Bird is on the loose, and her little legs are freaking fast. I'm working a lot, doing some traveling, and spending time with Chris. However, diabetes is still part of the mix, and I need to find ways to further fine-tune in pursuit of a more solid A1C, and to keep diabetes complications in their stupid boxes (because they are worth more in their original packaging). 

So what's missing? Testing? Bolusing? Dex'ing? Nope x3. What's missing, I think, is the stupid logbook. I hate logging. But every time I dedicate myself to it for a few weeks, I see good results. And sinceKEVIN! You are the shit, dude. I'm in a healthy stride, diabetes-management-wise, I need to just keep at it until the A1C starts to reflect the effort.

So I'm returning to Kevin. The Kevin spreadsheet (he should trademark that shit) is back and in full-effect, and I've been logging numbers. (It's only been two days, but I'm hoping I can stick with it.) Maybe this is the tool that's been missing from my arsenal. Maybe this is just a tangible reminder to stick with the anti-burnout program I've been working hard to make habit. Whatever it takes to bring this stupid A1C down, I'm in.

Before, it was about being healthy enough to have a baby. Now, it's about being healthy enough to be here for her for a long time.

Comments

I just started logging again too. It sucks, but it helps. You'll do great! Good luck! :)

god, i totally relate!!! i'm struuuuuuggling beyond reason: burned out, i may be, in fact. my a1c's creeped up and it upsets me. "guilts" me, as you said. and that last line---about being here for a long time---is my motivator. but ya, kerri, you are right on about hating logging and i've been thinking lately how that is what has always saved me. arrrrgh! this beast of burden! sending love---you're amazing and don't forget it, friend!

Awesomely timely for me, my friend. I finally (FINALLY) got the nerve to find a new endo and I meet him in 2 weeks.

Oh, ugh. I keep eyeballing that spreadsheet on my desktop, knowing I need to get back on that train too. At least you have an A1C - be proud you've got someplace to start from! I don't think I've had one drawn since July. July!

Here's to Kevin, to logging, and to getting back on that (rassa-frassa-frick-fracking) horse. You'll be in good company.

Wow.

You've got 3 comments, and I just got 6 requests for my logbook in the past 10 minutes. (I knew someone somewhere must of said something again!)

I hear you on the burnout front: I haven't used that logbook in well over a year (maybe two, even).

I've been relatively consistently below 7 with the Dex for the past year, so I've been pretty happy (especially considering my struggles to get there).

But I've been longing for a sub-6.5 for a while (I have elaborate dreams about doing some serious damage at a Cold Stone upon receipt of such a number).

Best of luck to you with the logging. And who knows, perhaps I'll jump back on that log-wagon again, too.

Oh, do I hear you! My last A1C was 7.5 and I worked my tail off so it was...tada...7.4! So frustrating--I feel for you.

But you know what's missing? It's not the log. It's our pancreases! ;-)

Congratulations on your 6.3% That's ideal!

I really don't like that doctors judge people based on their A1c's. It's like they take this teensy, tinsy part and say "oh, you're a bad person and you don't care about your health because your A1c is over 7". The A1c is reflective of the average blood sugars, but it doesn't talk about highs and lows and it doesn't talk about effort. It bugs me that doctors take it further than what it really is--a number reflective of control ONLY.

Also, about the whole logging thing. I doubt you want to give up the meter remote, but if you decide you hate logging more than you love the remote, the OneTouch UltraSmart meter really does it all. You can put in your carb and insulin doses, exercise, etc, and then you can plug it into your computer and download the data so it's all nice and organized. On the meter itself, you can view graphs of the last few days, averages by meals and weeks--it's a wonderful little machine that makes people like me (very, VERY nerdy when it comes to technology) thrilled that they don't have to do all that much other than press a few buttons.

I've gone through the burnout already and it's only been 2 years since I was diagnosed with T1D. ha

That logbook looks legit but for some reason I can't get his email to work for me...could you by chance email it to me?? (amanda@experiencelifenow.com)

Logging is definitely something that I want to focus on :)

Thanks for your continued transparency and wit!

I am so happy to stumble on your post. My 21 year old is a Type 1 pumper - has been since 10/25/2005. He's had a horrific 6 months which ended in the paramedics rescuing him on New Year's Day this year. He's back on the right track, but I just can't wrap my mind around him not checking his blood sugars and assuming he knows how much insulin to bolus. From reading your little post, now I get it - the kid was burned out on diabetes. Thanks for giving me a new perspective. The Mom

Remember the movie "What about Bob"? Baby steps, baby steps! The good news you are getting better numbers. Keep it up!

I can't get Kevin's email to pop up either. I would be interested in his logbook- anyone who can run SAS is my hero!

Great job Kev it will only get better.Oh, we try for perfection and at times it is elusive. But keep trying and I know you do. Stress can be a negative influence on ones body and sugars. So maybe think about how to destress and slow down a few notches maybe some Yoga or meditation. Love ya, mom

I totally feel you! I am trying to get pregnant right now, and have been working my tail off! I got sick last week, so my numbers were a little high during that. I go to the doctor next week to get my A1c done. My last one was in October, and it was 6.9. I'm a little nervous, however, but it is an average, and the holdiays will be factored into that one little number! I'm really hoping my hard work from the past month and a half pays off, even if it's just a little bit! I want a baby more than anything, but I want to be in the best health possible for that happens! I wish doctor's really understood that eating isn't the ONLY factor in raising blood sugars! My endo. gets it b/c she is a T1Diabetic, but her nurse practioner, whom I have been seeing latley doesn't seem to get it, and makes me feel guilty. Good luck to you, and take joy in the fact yours was lower this time than last!

The whole A1C thing, from pre test jitters to post test judgement is mentally draining!
I stress about my A1C weeks before I get my labs (cough, cough) and for weeks after I get my official A1C results. Good for you for logging! Go Gurl!

Being the mom of a PWD, but not having diabetes, I think that diabetes professionals, and those caring for PWD's, don't really know the effort it takes every minute, hour, day, week, month, & year ,etc. At Briley's camp, for 24 hours non-diabetic counselors had to test and get shots, so they would know what it is like to "live" with diabetes. Only 24 hrs - for them it was so long, yet for all of you what a gift to even get 24 hrs off would be wonderful. You are doing a good job. Always remember that.

Cynthia Boisvert

Wow, I can't believe this. I just came to your site to look for this spreadsheet TODAY! I got it from Kevin a couple years ago after you'd mentioned how much it had helped you - and on a side note, when I first skimmed the post, I thought you had a new doctor named 'Kevin'... ;)

I'm trying to get back on track too after going through a pregnancy with T1 and having a baby a year and a half ago. Can't seems to stop the roller coaster lately...probably doesn't help that I end up snacking all day on whatever my son doesn't finish eating... hoping Kevin's spreadsheet will help us all! Thanks again for reposting. Take care.

I guess I'm weird cuz I like logging. It must be the bookkeeper in me. It really does help me to see it on paper. (that makes it harder to ignore, eh?) It sucks when our effort isn't reflected in our numbers. I hate that when I try SO hard to eat better and exercise I don't see results on the scale or my fasting numbers start to creep up. We need to remember that, regardless of what the numbers say, we are doing well! Congrats on your increased awareness.

does anyone else use the quick-result A1C test at their doc's office? i love that i can do the test and get pretty good (i.e. reliable) results within 5 minutes. (at least then the waiting isn't quite as long.)

Sorry to hear. I know the feeling of frustration! I blamed hormones (true) and lack of follow thru on my end (very true!) but after 32 yrs with diabetes I was tired of excuses for myself, and then I tried eating a paleo eating plan. Not only have my blood sugars leveled beyond my wildest imagination but I feel incredible. No more "hormones" affecting the blood sugars! And talk about no-hitters! My minimed pump (and cgm) is my new best friend. I take pics of my graphs quite often because I'm awaiting for the peaks and valleys to return. It is not worth eating so much carbs....and I'm down to 18-22 units per day. Down from my usual 25-40 per day. Paleo is hard and takes a lot of planning (plus eating clean is pricey!) but I finally feel in control of my diabetes for the first time in 32 years. Im anxious to see my next a1c but I've only been doing paleo for 2 months so hopefully the next drs appt will be a good one.

Regarding A1Cs, I honestly believe that you can't compare values from one test done at one place to those from another test at another place. When I was young (pediatric-endo years), he insisted I use the same lab EVERY TIME from one A1C to the next. My previous (before current) endo used to do the fingerstick A1Cs in his office and also send bloodwork to a lab. The fingersticks were conistently about .3 lower than the labwork. They both showed the same trends, but the numbers were different.

Rotating between A1C tests/testers is like using a OneTouch before breakfast, an AccuChek before lunch, and an Bayer Contour before dinner. They're all good, but they've all got subtle differences. Sick with one test/tester to get a true perspective.

Kevin's was my first! (logbook..)

They called me yesterday with my A1C result & I was kind of shocked and starting to think that number isn't as reliable as docs would like us to think. Mine was really low. Lowest I've ever had. While my diabetes has been behaving for the most part, it just ain't been THAT good.

I say that if you're feeling better then you're heading in the right direction. And if logging will make you feel even better then go for it. Goodness knows Kevin's logbook ROCKS! (Kevin, seriously you NEED to trademark it or patent it or something!!)

If there's anything I can do, let me know. Not sure what I could do from here, but I'm willing. :)

And regardless of your A1C, I think you're absolutely fabulous. :)

"Before, it was about being healthy enough to have a baby. Now, it's about being healthy enough to be here for her for a long time."

SO FREAKING WELL SAID. I feel like this everyday, except I'm pregnant again so I'm kind of both right now.

Thanks for another great post. I love reading along!

I have used my Track 3 to log information before and know I need to start doing it again to get a handle on my blood sugars. They have been climbing and I need to put the brakes on them. Kerri, you inspire me to get back on track. Thanks.

Thanks for the great ... and timely ... post Kerri! Very well said ... so inspiring! I was on track last year ... rockin' Kevin's spreadsheet for 13 weeks straight. I had to or else I would not win my bingo/blackout game (another one of your fabulous posts). As soon as my 13 weeks was up ... burnout set in ... which begs the question ... what was my motivation? Winning a fabulous purse (aka diabetes suitcase) for completing all 16 goals or living a better life despite type 1 diabetes? My last A1C was proof I have not been paying attention. I "dusted off" the spreadsheet just two days ago too and I already feel more in control. If I see Dex on the rise I am testing and treating as I don't want to see a single BG over 200. A simpler approach this year ... log, analyze, and adjust. Here's to seeing the other side of 7 sometime this year!!

Kevin's logbook is amazing! I don't know what I'd do without it. I'm on my second pregnancy and use it every day.

App. There needs to be a Kevin Logbook app.

We are kindred spirits; I hate to log....but it does soooooo much to lower my A1c and overall feelings of empowerment. This was my stance last time I decided to log.....I decided that it didn't have to be an all or nothing. I made myself a promise that each time I started to log, I would do so for 4 consecutive day....and then if I wanted to take a break for 2-4 days I could. It helped me to know "you don't have to do this forever....just do it for four straight days" and "you CAN take a break and then start back up".

It may not work for others....but it did work for me.

Can you explain how this logbook works when you are already wearing a Dex? Do you use the information from the Dex and record that on the logbook? and how does the logging differ from the reports that the Dex produces? (I'm a fellow type 1, struggling to get below a 7.6 no matter WHAT I do...)

Good for you Kevin, I knew you could do it. Best Regards, Dee

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