For the first time in months, I sent a lengthy e-mail to M's Diabetes Nurse Educator (DNE). These e-mails are a pain. In order that she might give us appropriate advice, we need to include the following information:
1) number of carbs M had every time she ate
2) What her bg level was each time it was tested
3) What time of day she tested her bg
4) What her carb ratio is each time she injects herself
5) What the correction factor is each time she injects herself
6) How many units of insulin she injected and what time she injected it.
7) All of this data over a minimum period of four days. A week is preferable for tracking trends.
We track all of these things in a little notebook. Then I have to transcribe them into an e-mail.
It took me over an hour to compose this e-mail.
A few hours later, I check my inbox. I got an "out of office" reply. She'll be back on X day due to a family emergency.
Doesn't she know that she is not allowed to have family emergencies?
The message also indicates who to call if we are having an urgent problem.
Well, a funny thing happened as I was transcribing all of the necessary information into the e-mail. I began noticing patterns, and began exercising a part of my brain that had been dormant for the past few months as I sat back, smugly satisfied that M had everything under control. Perhaps it wasn't quite urgent enough to call some stranger, no matter how well-educated they are.
Which part of the brain is that? The mathematical? The emotional? No. The diabetes part.
Oh, yes. There is a diabetes part of the brain, it's just that most of us have no use for it most of the time.
So, her bg is lower at night, but REALLY HIGH at morning snack, lunch, and afternoon snack. By dinner, after so many high doses of humalog, the bg has been wrestled more or less into range. In other words, its REALLY HIGH nearly all the time except at night when it sometimes is REALLY LOW.
So here's the plan: Raise the Lantus by one unit to (the obscenely high number of) 42 units. Increase the correction factor by 2 at night, thus offsetting the higher dose of Lantus. Reduce the correction at breakfast to tackle the high numbers yet to come.
We had a "good" day yesterday, with bg ranging from 87 to 205. We did have one crazy 340 mixed in there the other day, but the mystery was solved when it was revealed that M had not calculated her yogurt into her dinner carbs. 25 uncovered carbs can wreak havoc on your bg levels.
While this range is not what I am accustomed to (something like 75-165), it is much better than the 29-398 of the past weekend. We are continuing to tweak ratios and corrections as we prepare for our big "Pump discussion" with the DNE next week.
Two end notes here. I am now tracking all of M's info on a spread sheet set up by my adorable engineer husband, who likes to analyze and eliminate variables. I sent it as an attachment as I e-mailed this new info to the DNE. That was much less time consuming, and all of the data is now at my fingertips. As long as I am at my home computer, that is.
When I sent it, I got another out of office e-mail. Sadly, this one said that the DNE would not be in the office due to a death in the family. I will have to assuage my Catholic guilt for cursing her family emergencies by buying her a sympathy card.
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| "I hope they have sympathy cards where we are going." |
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