I recently discovered the Flatliner's Club club on TuDiabetes.org. The club is described thusly:
A club to share your success and not so successful trends graphs (all graphs time wise are welcome, 1hr to 24hr) from your CGM or Glucose Meters...
I started up some conversations that at first seemed confrontational. Quite frankly, I missed the second sentence in the club's description.
"Post your trends, don't be bashful. There are not many things better in a diabetics life than discussing glucose trends (good or bad) with other diabetics. Remember, the bottom line is this group is for support, not in anyway a competition."
Not reading that second sentence got me into a few heated discussions on the forum. I felt that the expectations of what people should be willing to do to maintain normalcy in their blood sugars were too much work given that people with diabetes (PWD) also have work lives, family lives etc. that need attention.
It was only later when trying to get my blood glucose (BG) numbers under control that I realized that perhaps I had over-reacted. Perhaps I was feeling the wounds from my battle with the diabetes monster. But I did find people, like Zoe, who felt that the tone of the club could be taken the wrong way.
So I set a goal to correct the issues I was having with my A1C and weight etc. I decided to join the club. My goal is to be in target range about 80% of the time, with a BG between 70 and 140. I felt that aiming for tighter ranges would be a burden for me and increase my stress which runs counter to control BG. Some in the club aim for a very narrow BG range between 65 and 85. While I think that is achievable, the level of attention -- testing, adjusting, micro bolusing, etc. -- would soon occupy most of my waking hours and borders on obsession. I also don't think I need that sort of narrow range to get an A1C between 5.5 and 6.
I have had some success meeting those goals in the last few weeks but overall I still have a challenge in the evenings. I discovered that changing my infusion set the manufacturer recommended cycle help reduce the likelihood of severe hyperglycemia. I had developed a bad habit of leaving my infusion set in for one or two days longer than Accu-CHEK recommended. Once I started changing my infusion set on a regular schedule the incidence of severe hyperglycemia dropped.
Someone on the forums mentioned that Dexcom's Clarity app was now freely available to use but they also recommended Diasend. This two-week chart from Diasend1 shows my average daily BG ranges and I am happy with those results. Based on this trend my A1C is expected to be between 6.1 and 6.6. This is a huge improvement. Just a few weeks ago, my A1C was 7.4.
One thing that I learned from reading the posts in the forum is that while the effects can be slower, protein and fat have an impact on blood glucose. I started bolusing for protein and the fat in my meals. This isn't something I have experience doing so I have become dependent on an app called, PredictBGL. I know what my carb ration is -- 1⁄7 or 1 unit of Novolog for every 7 grams of carbohydrate -- but I don't know how much insulin I should take for the fats and protein in my meals. The PredictBGL app helps with that.
It took some time to enter my ratios and a lot of other information into the app. However, now that all the setup is complete, I simply enter my current BG, meal carbohydrate, protein, and fat values, and the app computes a suggested insulin dose. The doses are usually a few units higher my bolus advice from my Accu-chek Avica Combo meter.
This regimen seems to be working for me. I am getting the results I want. The only downside is an increase in lows -- hypoglycemia -- which I think is just par for the course, some extra time spent in data input, and ensuring that I change my infusion set regularly. Attempting this type of tight control over BG can challenging and you may not be able to get the results I did. But I think it's worth a try.
- I'll do a review of Diasend and PredictBGL in another blog post. There is more to PredictBGL than just bolus advice and Diasend does too much go into here. ↩