August 12, 2009
Ramona


A couple of days ago I had a routine visit with my endocrinologist. I’ve been using a CGM for several months now, and I was sure my A1C would be less than 6.9, my last reading. When my doctor said 7.0, I was momentarily dismayed. “At least I have something to work towards for November,” I sighed.

The A1C is a hard number to move! But looking at all the data my doctor downloaded from the CGM, it seems like it shouldn’t be. It’s easy to look at a blood sugar graph – whether it looks like the Rockies or the beach – and determine what went wrong or right to produce that particular line. The sensor, pump and meter hold so much information, it’s possible to retrace almost every step to figure it out. It is science, after all: carbohydrates and insulin cancel each other out. Tweak a few things for exercise, stress, illness, hormones, and so on, and voila – there’s the formula to balance your blood sugar!

Of course, that’s not reality. Sometimes it’s frustrating to be armed with so much information and still not get things “right.” 15 years ago my doctor just asked me, “What’s your average morning blood sugar?” Instead of stuttering, “Uh, er…” I usually just made up a plausible though respectable number, and that was the end of that. Now, my doctor doesn’t have to ask me anything. He just plugs me in and has every last detail of my diabetes management memorialized on the screen in front of him. I know, more or less, what my blood sugar is every minute of the day, how many carbohydrates I’ve eaten, and how much insulin I still have on board. So why isn’t my A1C 5.5?

The answer, I know, is because I’m a breathing, moving human being, not a Petri dish. There are innumerable irregularities that throw things off. Plus, I often decide to let other things take priority over my blood sugar. Sometimes, large pieces of cake with double thick icing take priority; sometimes, fueling on long bike rides takes priority. And that’s ok! It’s ok to take only 50% of my bolus and let my blood sugar rise before a long workout. (My doctor calls those blood sugar spikes “excursions,” which makes me think of my sugar-filled blood traipsing around the Himalayas with a rucksack.) The cool thing is, if I trust the science and stick to my program, it will usually come back down.

Training for the triathlon has made me chew over this stuff a lot recently. For years, I’ve been on auto-pilot with my diabetes (not to say I’ve been managing it well, just that I’ve been managing it without thinking much). It’s great to have something come along to shake things up. My A1C might still be 7, but at least now I can bike 56 miles.