The only constant in diabetes is that it's always changing. Numbers go up, numbers go down. Medication doses change. Your body changes. So how on earth do you figure out what to do when things start to go haywire? This month's Diabetes Social Media Advocacy (DSMA) carnival is focused on exactly that:
When it comes to diabetes, sometimes it seems things change more than they stay the same. Every so often, we may start to notice things going a bit out of whack and some new blood sugar patterns emerging. Part of being an informed and educated patient is learning to identify these problems. So this month we'd love to hear: What are the best resources you have used to help troubleshoot?
When it comes to fixing problems in my diabetes, I am painstakingly slow. My blood sugars can spike in the late afternoon for a whole month before actually sit down and realize that I've been correcting every single day for 30 days and that maybe I should do something about that? After all, recognizing you have a problem with the first step toward solving the problem!
I have a few resources I use when it comes to troubleshooting. First is my own knowledge. After having diabetes for 17 years, you start to learn a thing or two about diabetes. That doesn't mean you always put that knowledge into practice, but I have done enough basal and bolus corrections that I know how the process works. My diabetes educator and endocrinologist have actually taught me how to do it myself, though it's always wise to check with your endo first. But let's get real - you might not call for every single issue you have. Some things you're just going to do on your own.
Other than the "on the job" experience of living with diabetes, I've also got a fair bit of book-learnin' too. Two of my favorite books are Think Like a Pancreas by Gary Scheiner and Pumping Insulin by John Walsh. Not only are they chockful of info, but both authors have type 1 diabetes themselves! Both of those are amazing resources for helping you understand how your body works, and how technology and medication can - and most importantly cannot - mimic a pancreas. Some of the legwork you have to do yourself. I also recently read Your Diabetes Science Experiment by another type 1, Ginger Vieira, which I felt was really helpful in teaching me how to ask the right questions and look in the right areas, so I could see what the real problem is.
If I absolutely get stuck or I have no idea what the heck is going on, then I often rely on the experts. When I was in college, I worked regularly as a client of Gary Scheiner, who helped keep my A1c near 7% - a modern miracle if you ask me. Sometimes I still send him little notes when I feel like I'm drowning.
And of course, I can't leave out the DOC, whose tips, tricks, and regular "Well have you tried..." have blown the lid off more diabetes conundrums than I can count. You can't take patient experience as Gospel Truth, but it sure is helpful when you're at your wit's end.
To my mind, living with diabetes is ALL ABOUT troubleshooting. It's basically all you do, all day, every day. That is, since dosing insulin is not an exact science, you have no choice but to be reactive.
I wrote all about A Lifetime of Troubleshooting a couple of years ago, and am glad to have the opportunity to revisit that pivotal post:
Since being diagnosed with diabetes, I feel like a Meister Troubleshooter. It's not just some watchword for the workplace anymore, it's a lifestyle. It's what is known as diabetes management — just a fancy term for trying figure out what's going wrong with your blood glucose control every day of your life and how to fix it.
Basal programs, temp basals, insulin-to-carb ratio, that tricky carb-counting, infusion site rotation, wacky readings, warning arrows, high alarms, bum test strips, hidden carbs, dual wave bolus, ... weigh & measure! It never stops...
When your blood sugar suddenly soars and it won't come down, as was the case with me for four whole days last week (!), you run through every scenario: Is my pump malfunctioning somehow? (maybe this pod or that one isn't connected right?) Or is the insulin fried? Am I even getting accurate readings on my meter? Or am I just on my way to developing a nasty cold?
If you think about it, these are the four basic points of failure:
1. The insulin delivery device
2. The insulin itself
3. The blood glucose monitor
4. The human body
The trouble is, the human body is more complex than all the other factors combined. That means no matter how well the technology works, you can always have blood sugar control issues that seem to escape logic.
So what are the best resources I've used to help troubleshoot? I'm with Allison: there are some very good books out there. But when I'm "in the moment," I usually start by putting on a fresh pod with fresh insulin to rule out the device-failure factor. I think about whether I'm getting sick, or if I'm overtired, or if it's that time of the month. If the trend seems unstoppable, I definitely contact my CDE (also the wonderful Gary Scheiner).
Here's the carnival question that stumped me most: "At what point do you identify a trend in blood sugars that needs corrective action?" Right. When do some poor results become a trend? I've been running pretty high after meals lately, so took it upon myself to reduce my Insulin:Carb ratio on my pump. Now I wait. Will this help? Or is it something else sabotaging my control?
The only thing that's for sure is that the troubleshooting trend WILL continue.
To participate in the DSMA blog carnival yourself, click here for instructions. You can also follow the Diabetes Social Media Advocacy Chat on twitter every Wednesday night at 9pm EST. Follow @diabetessocmed or the hash tag #dsma.