Tuesday, December 29, 2015

Sugar Surfing For Good Blood Sugar Control

I'm not a huge fan of carb counting and never have been.  Many years ago, when I was newly diagnosed with Type1, like all good diabetics do, I began weighing and measuring my food, figuring out the carbohydrate amount, and then dosing my insulin injections based on that. But at best, my carb counting has always felt like a guessing game. I can eat the exact same thing and have the exact same amount of insulin with great results one day, and repeat it on a different day with either high or low post meal blood sugars- Neither of which feels good at all.

Obviously, when I have low blood sugar, I have to react and treat it.  So although it feels awful, and is often embarrassing and a burden, it never stays low for an indefinite period of time.

But with high blood sugars... Well, I USE to just wait until my next meal to take a shot. In the past, I'd been told by my doctors to not stack insulin doses, and I was also told to only take insulin before eating a meal. I held on to those rules for many years.

Which means... I would have hours of high blood sugars when my insulin coverage wasn't enough.  But over the past year or so, I've learned by trial and error how to avoid staying in a high range for more than just a short amount of time.  On my best days, when I'm really on my A game, I can avoid those high blood sugars all together.

I still obviously sort of count carbs (I "eye-ball" things, but I don't weigh and measure), but I don't worry too much about being spot on with my calculations- I can make adjustments when I see my Dexcom CGM trend graph start to head in the wrong direction. Sometimes, like after eating a high protein meal, my blood sugar is fine the first few hours. But around 3-5 hours post meal, I get a little rise.  When I see that upward trend begin, I just take a little insulin to cover it.  And that line on my Dexcom that was rising, dips back down and straightens- right where I want it.

One day, I received an email from JDRF about an author coming to Dallas to talk about Sugar Surfing.  I had heard the term "Sugar Surfing" mentioned on a few Type 1 Facebook groups that I belong to.  I knew very little of what it was all about, but I knew it sounded like something I was interested in.  So I signed up for the event.

It was a very motivating presentation.  Dr. Ponder, who is an endocrinologist that has Type 1 himself, went over many graphs that explain how he uses his CGM to maintain tight blood sugar control.  He makes it easy to understand and also interesting.
Dr. Stephen W. Ponder at a "Sugar Surfing" talk in Dallas
He definitely motivated me to do a better job keeping track of what I do. Since attending his event, I've started using the Dexcom 5 app as a spot to quickly and easily record how much insulin I take and when I take it.  That way, if I've forgotten the amount or exactly when I last took a dose, it's all right there so I can easily take a look.

So the myth that stacking insulin, or taking insulin between meals is a bad thing is officially dispelled. Instead, it turns out to be a huge reason why my A1C is currently under 6%. And I plan on keeping it there, by the way!

And yes... I do run into low blood sugars a fair amount of time, but nothing overly dramatic.  In fact, often, I can just eat about 5-10 grams of carbs and I'm right back up in the 80s.

There's a Facebook group for Sugar Surfing you can check out.  Dr. Ponder posts tips, his CGM graphs, and mentions when he'll be out speaking about his Sugar Surfing book.  The talks he gives, by the way, are free of charge.  When I went to the one in Dallas, I intended to buy his book, but the line was pretty long and I had another meeting to get to. So instead, I went home and ordered it online from Amazon.
Sugar Surfing by Dr. Stephen W. Ponder

I haven't actually finished the book- but it's a great reference tool for how to use your CGM to tighten your blood sugar control.

Anytime I make changes in my plan for managing my blood sugar, I do it gradually.  That way, I'm not taking any big risks. I've learned that when I make drastic changes, it never seems to go over very well.  So, please...be safe! 

Now that many of us are lucky enough to have a CGM, we can manage our blood sugars so much more effectively.

Sunday, December 13, 2015

Getting the Most Out of My Dexcom CGM

Can I just say thank you so much, to all the nice people that read my last blog post and sent me supportive comments?!  That totally and completely made my day. And it was already an awesome day to begin with.

So, I definitely wanted to get started on sharing a few of the things I've done to get that A1C to my all time lowest- and best.  Like I mentioned in that last post, an A1C is just a number.  But all of us Type 1s care a lot about it!  We all want it as low as we can get it without having to suffer through a lot of low blood sugars.

My style of blogging, which I'm sure you've noticed if you've read a few previous posts, is to keep things pretty short and sweet.  So although I've got a whole list of things I've been implementing and unimplementing (that is a word I just made up, and obviously, it's meaning is: v. the opposite of implementing) I'll just focus on one thing at a time.

Today, I want to start with the biggest game changer that's come into my life over the past few years:
My Dexcom continuous glucose monitoring system.
Dexcom G4.  My first CGM.  And a total game changer for me.
It's been over 20 years since I was diagnosed with Type 1 diabetes.  So 20 years ago, I was on a big learning curve.  I read every book about Type 1 I could get my hands on.  And I went to a few (very depressing) "support group" meetings.  I learned as much as I could about my brand new disease from my doctors and those books. (Because the internet wasn't around back then!)

And then, once I got my blood sugars relatively under control, I just kept doing what I was doing.  I sort of forgot that new information was probably coming out all the time.  And because I've been coasting along, and doing okay with my blood sugar control over the years, my doctors sorta kept me on auto pilot.  For 20 freaking years.

But fortunately, I have a friend named Tanya, that also is a Type 1.  And she is constantly trying new things like pumps, and meters, and medications that other than through her, I never even would have heard about. To be honest, although I love hearing about anything she has told me, I personally didn't have a big interest in it for myself until she showed her Dexcom to me one night at dinner. My A1C had started slowly creeping up over the years- nothing super alarming, but getting to see a graph of my blood sugar over a 24 hour period sounded like something that would be helpful.

I didn't know if my insurance would cover such a thing, back when Dexcom was new on the scene.  I actually volunteered to be in a clinical trial in which I would've had to use a Dexcom, and would have gotten to keep it- that I didn't qualify for.  Boo hoo. But then I thought, "Hey, I should at least ask my insurance if they could help cover it."

As the saying goes, "Ask and you shall receive."  I asked and I got my first Dexcom free- well, technically, I had already met my deductible.  I think I had to pay 10% of the cost.  But it felt free enough, and I was very happy.

I thought I would just use my Dexcom here and there- like maybe one week every month or two, just to get an idea what my blood sugars were doing over a 24/7 period.  I also (wrongly) thought the big appeal of using a Dexcom was not having to prick my finger as often for a glucometer reading.

From Day 1 of inserting my first Dexcom sensor, I haven't gone a single day without it.  As advised by the Diabetic Educator that showed me the ropes so to speak, in the beginning, all I did was look at the trend graphs.

I just watched for a few weeks.  But then, once I understood a few things like how long it seemed to take my insulin to make a move on my blood sugar before a meal, and what my blood sugars were doing a couple of hours after eating and while I slept, I couldn't help but make changes.  Little ones at first.  And I got bolder and bolder with my insulin dosages as I became more knowledgeable based on the knowledge Dexcom gave me- Knowledge that I was never privy to before.  Now I don't just take shots before a meal or bedtime.  I will take small doses of insulin throughout the day when I notice it going too high.  I'm not at all scared of lows, because my doses are very small (1/2 unit doses with my insulin pen) and because I know the Dexcom will show me what's going on as my blood sugar is falling.  I can take a small amount of carbohydrate if necessary.
Dexcom G5 on the iPhone

So I have to say... Of all of the things that have allowed me to make a positive change in my overall diabetes care Dexcom is number 1.

It also piqued a whole new interest in this disease that I'm not sure I ever had, at least to this extent, before. Looking at my trend graph throughout the day is a huge motivator.  I can't help but react to the numbers.

I'm now using the Dexcom G5.  I like having it on my phone, but sometimes, I prefer the little meter Dexcom provides.  (If you're interested in my comparisons of the G4 and G5, I wrote a blog post about it, which you can read about by clicking right HERE.)

In my next post, I'll talk about Sugar Surfing, which is my other huge discovery as of late.  There's no way I could do "sugar surfing" without having the data that a Dexcom provides.

Thanks so much for reading my post today, and for visiting my blog.  Please leave a comment if you have anything at all to say and add to the conversation because that's what makes for a good blog, and I am sure aiming for having a great blog focused on Type 1!  Please don't be shy- I'd love to hear anything you have to say, and I'm sure other readers would as well.  

Monday, December 7, 2015

My Lowest A1C EVER

Well... I got my A1c results back from last week's endocrinologist appointment.

And I'm super duper happy. 

It wasn't quite as low as the Dexcom Clarity app had predicted (although, I suspect, given a little more time- it could be!) but it was the lowest it's ever been since I was diagnosed as a Type 1 over 20 years ago.

So give me a drum roll please, because this feels like a very important announcement and a very proud moment for me....



I've heard it before, and you probably have too...But it bears repeating. This A1C is really just a number.  In fact, at my last appointment, when I told my endo I was shooting for an A1C of 6% or lower, he warned me, "Don't get too caught up in your number."  First of all, everyone's disease (and body!) is different.  Secondly, it's way more important to avoid extreme high and low blood sugars than it is to have a low A1C. If I was having a bunch of lows, this number most certainly wouldn't be worth all my trouble.  Thirdly, one can become a little obsessed trying to achieve a low A1C.  (I, however, find my particular obsession pretty manageable.  My world doesn't absolutely revolve around it.)

Cheerleader #1, Lucy!
Cheerleader #2, Ricky Ricardo!
Still, I'm yelling out my number to anyone who gives a shit.  Which, come to find out, actually isn't too many people.  Lucy and Ricky, of course, were thrilled for me and gave me loads of kisses for all the hard work it took for me to achieve that 5.7.  I called my husband while he was working and although I'm sure he was happy for me, I don't think he really gets it. And I sure don't expect him to. I have just a couple of Type 1 friends that I texted with my results, even though it may have been a little braggy.  But I couldn't help myself.  I knew they would get it and feel happy for me.  Like I said, there's just not that many people to tell. 

I know this A1c is an ever-changing thing.  And although I've worked really hard to get it this low, I'm sure I had luck on my side as well.  Next time I go in for labs, who knows?  But maybe I can keep hovering around 6% for a while, now that I've proven to myself that it's possible!

I'll obviously post more (and more) very soon about little adjustments I've made that for me, have made a big difference in my blood sugar control.  As well as currently having this 5.7% A1C, I have far less problems with highs and lows than I was having in the past because of these little changes I've made.

But today... It's just a brag.  It's not every day I feel like bragging.  But holy guacamole, today I do!  So thank you for indulging me!