At each appointment with my endocrinologist, I have the opportunity to review my meter readings, pump settings, and daily averages from the last few months. In addition, I receive an HbA1c reading, which represents my average blood sugar from the past three months. Levels of HbA1c are not influenced by daily fluctuations in the blood glucose concentration but reflect the average glucose levels over the prior six to eight weeks. The HbA1c value is useful because it indicates a more precise average value, as opposed to the meter average which is usually swayed by the circumstances that I test more.
At my last appointment, I was especially curious about my most recent HbA1c, because it represented my first semester at college. I had made significant changes to my daily schedule- the times that I slept, ate, worked out, and went to class were completely different. I wasn't sure to what extent my HbA1c would reflect all of the ups and down associated with the adjustment.
My HbA1c was a little bit higher, but still within the range that my endocrinologist established as my target range. At first, I was extremely frustrated that despite all the work that I put into managing my blood sugar, my average was higher. I felt like I had done everything that I could to minimize highs, lows, and swings between the two. However, it was difficult to nail a daily insulin routine because each day was so different!
Most diabetes educators recommend establishing a consistent daily routine to make managing diabetes easier. "Keeping a routine when you have diabetes can help ensure adherence to diabetes management," according to Maria Koen, C.D.E., nurse practitioner, at Joslin Diabetes Center. "It helps establish consistency in blood glucose levels and reduces the risk for severe blood glucose fluctuations." I experienced the benefit of a routine in high school. Because I didn't have a lot of flexibility, I kept nearly the exact same schedule every day. I woke up at the same time, ate breakfast, and went to school until the same time. Every day, I ate lunch at the same time, exercised at the same time, and usually went to bed around the same time. Even though it was monotonous, it was easy to fine tune my basal rate to my activity at all hours.
By contrast, my college classes are at different times every day. I have classes at 8am and classes at 8pm. Breakfast, lunch, and dinner, are always at different times, and not always at conventional hours. Last semester, I rarely found myself comparing one day to another, because my schedule was so much different. In fact, my blood sugar was almost completely impossible to predict a few weeks into the semester when I had established my weekly schedule. The higher HbA1c reflected more on my erratic schedule than a lack of effort.
Essentially, the ‘freedom' that makes college so great comes with a much greater responsibility surrounding diabetes management, and I have to be more aware of my blood sugar all the time. But, I love that each day is different. What I learned is that there is a tradeoff between monotony and tight blood sugar control. It is easier to keep blood sugar normal when every day looks the same, but, at this point in my life, living like that is not realistic. I am willing to sacrifice the predictability and comfort of a routine to be able to do all the things that I want to do. As long as I put the extra effort into managing my diabetes, I can continue to enjoy my dynamic week and the variation day to day. Who knows what tomorrow will bring?
