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It’s Not a Test

Maryam Elarbi

April 12, 2012

This week I had an appointment with my CDE, Gary, who I’ve been seeing since I was diagnosed. I remember when I initially started seeing Gary, I was always super nervous because he was a Type 1 pro — in addition to being a certified diabetes educator, he has Type 1 himself.

This appointment, like my recent appointment with my endo, was the first without my parents. I knew going into it that my mom and dad would want to know exactly how things went, and knowing that I’d have to report to them immediately afterwards forced me to pay extra attention.

I felt pretty good about the appointment until I actually got there and it was time to take my A1C. I know that I’ve done it a million times before, and I’ve even blogged about things like this saying it’s not a pass/fail test, so there’s not reason to get so worked up about it. Nonetheless, I couldn’t help having some jitters about it.

While the number was being processed, I blurted out to Gary that I was nervous, and he basically told me to not be ridiculous. That it is what it is. (Sounds all too similar to the advice I give everyone else!) When it was finally done, I ended up guessing my A1C exactly right.

At this point, I don’t think I’ll share what it was. I don’t want any readers to go based off my numbers or feel the need to compare. (That’s actually one of my least favorite things about diabetes — the fact that so much of it is measured in numbers makes comparisons all too easy!) In any event, I was content with the number. It was back in a range that I haven’t been within for about year now, so it was nice to reach that benchmark after it had been out of my grasp for so long.

The appointment itself went very well, and I gained so much from it. One of my really terrible habits is bolusing for meals based on units of insulin rather than on carbohydrate counting. I have my insulin-to-carb ratios memorized, as they’re fairly consistent throughout the day, so I’ll just do the quick multiplication in my head and go from there.

On occasion it’ll work out well, but for the most part this method leaves my blood glucose levels out of range enough that it’s clearly not working overall. While I can easily calculate the amount of insulin I need on the strict carbohydrate ratio side of things, I’m clearly not factoring in insulin on board (the insulin that is still active in my system from previous infusions) or the adjustment I need to make based on what my current blood sugar level is.

Of course if I’m anywhere in the 200’s or hovering in that area, I’ll do a correction and then bolus for my meal, but still, it’s not as accurate as it could be if I used my insulin pump’s “ezCarb” function (which helps determine what bolus to give for the carbohydrates I’m eating) to its full extent.

Another thing that Gary pointed out to me is that not entering my blood glucose levels — aside from the high ones — into the pump when I’m calculating boluses makes it almost impossible to analyze the data to see what is and isn’t working. Essentially, because I’m only putting the high numbers into my pump, and rarely the good ones, the data collected makes it seem like I’m out of range 95% of the time. Hence, the data is becoming useless in the grand scheme of adjusting things.

It’s easy to get caught up in bad habits when it comes to diabetes, especially when you’ve had it for years. As I write this, it seems so obvious that I’ve been ridiculously lazy when it comes to having the maximum control possible. The thing is though, once you’re caught up in the bad habit, it suddenly becomes routine. I wasn’t even thinking about the fact that I was doing something wrong…it just became my routine to give insulin in terms of units versus carbs.

So think about your diabetes routine and if you have any bad habits you should probably kick. And if you think of something, MAKE A CHANGE! I’ve had to catch myself so many times this week for simply trying to bolus units. It’s not easy, but I know that if I keep it up, the good habits will eventually become my routine!



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