A Bad Case of Diabetes Burnout
Since the summer of 2006, my diabetes control has been quite good. My A1C has stayed under 6.5% consistently and even reached as low as 5% during my first pregnancy. After Sienna was born, I hoped that another pregnancy would be in my future, so my blood sugar remained tightly controlled.
But, now that Mateo has completed our little family of four and I'm likely done having biological children, I'm in the middle of a pretty bad case of diabetes burnout.
Partly it's due to the chaos of having two small children, working full time, and keeping everything juggled. There have been several meals that I half consumed before I realized that I hadn't tested my blood sugar or bolused insulin yet! I have found myself snacking without even attempting to count the carbohydrates or read the nutritional label, much less bolus accurately before eating.
When blood sugars in the 200 mg/dl range pop up on my meter, I barely bat an eye; whereas numbers that high would have demanded a lot of attention during pregnancy.
But when I noticed that even blood sugars hovering around 300 mg/dl weren't absolutely shocking and upsetting to me, I had to acknowledge that my burnout was severe.
So, I've started to proactively address some of the factors that have contributed to my out of control diabetes management:
First, I noticed a pattern related to my insulin site changes. During this last pregnancy, I used Novolog insulin, after several years of pumping Humalog. The theory was that Novolog might have a slightly faster start-up time. Since I didn't notice an improvement in insulin activity with Novolog, when I received a memo from my insurance that Humalog has a significantly less expensive copayment, I opted to switch my prescription and return to using Humalog.
A few months later I recognized that the insulin seemed to become less effective during the last 12 hours before a site change was due. I recalled that my CDE mentioned that Novolog was "more stable" in the pump than Humalog. That seems to be my experience. With Humalog, my blood sugars spike before the site reaches the 72 hour mark. I've been attempting to change the site every 2 ½ days to compensate for this difference.
Secondly, I return to the old faithful routine of logging my blood sugars. There's just something psychological about writing down blood sugars and review the patterns that helps me to make better decisions, calculate boluses more accurately and generally stay in better control. Simple, but it works.
Finally, I haven't done it yet, but I'm considering putting my continuous glucose monitor on for awhile. After a few lows that snuck up on me, it seems like it might be a useful tool when I'm running around at work or after the kids and sometimes let several hours go by without a finger stick test.