8. Support year-round exercise
This deserves special attention because of the tremendous influence physical activity has on blood glucose regulation. Often, kids get involved in sports or other physical activities that are intermittent. They may be very active on weekends and “slugs” all week. Or they may run like crazy in the summer and fall, then sleep their way through the winter and spring. These types of inconsistent activity patterns cause major changes in insulin sensitivity, or how well the body’s cells utilize insulin to lower blood glucose.
As mentioned in item 9, above, consistency counts. And that goes for physical activity as well. Encourage your child to stay physically active on a regular basis, year-round, and provide the support he needs to do that. And remember, if all else fails, there is nothing more effective than leading by example!
7. Keep records
As annoying and time-consuming as it can be to keep written records, there is nothing like them when it comes to achieving and maintaining high-quality blood glucose control. Sure, you can upload the data from the memory of your child’s meter, pump, or continuous glucose monitoring (CGM) system to your computer. But there is a psychological advantage to writing something down: It makes us instantly accountable for our actions. And if the records are kept in a format that is easy to analyze, they let you take a step back and see how things are going.
In general, I find that people who keep written records are able to achieve better control than those who do not. Records should certainly include blood glucose levels, but they can also include factors that affect blood glucose levels, such as insulin, carbohydrates, and physical activities. Many people find that blood-glucose-only records work fine until a problem comes up. Then, more detailed records enable more effective troubleshooting. A series of log sheets that can help with record keeping can be found at my Web site, www.integrateddiabetes.com/logs.shtml.
6. Think like a pancreas
A person’s insulin program should match his body’s needs as closely as possible. In a person who doesn’t have diabetes, the pancreas takes care of this by releasing a small amount of insulin around the clock and larger amounts after eating, when a lot of glucose is entering the bloodstream. It also makes minor adjustments throughout the day as a person’s insulin needs fluctuate because of exercise, the release of other hormones, etc. The ultimate goal is to keep blood glucose levels in a fairly narrow range, so that the cells that need glucose have it when they need it, and so that the bloodstream is not inundated with sticky glucose.
A person who has Type 1 diabetes (and some with Type 2) accomplishes this by injecting or infusing insulin. To replicate the pancreas’s slow, steady release of insulin around the clock, basal insulin is used, and to handle the glucose from meals, bolus insulin is taken.
When injecting insulin, a long-acting insulin such as Lantus or Levemir may be used to serve as basal insulin. When using an insulin pump, a small amount of rapid-acting insulin is infused all the time to provide basal insulin. Whichever method you use, your basal insulin should hold your blood glucose steady when you haven’t eaten or taken a bolus of rapid-acting insulin for several hours. This is usually best accomplished with an insulin pump.
The amount of bolus (mealtime) insulin should be matched to the amount of carbohydrate being consumed, with appropriate adjustment for the premeal blood glucose level, anticipated physical activity, and amount of insulin remaining (if any) from the previous bolus. (If any of these concepts are unfamiliar to you, talk with your child’s physician or certified diabetes educator about learning more.) Again, this can be accomplished through injections of rapid-acting insulin at each meal and snack, but it is far easier and more practical to do with an insulin pump. Today’s insulin pumps have built-in software that can help calculate correct bolus dose sizes, and they can give doses in very small, precise increments.