While on paper it all looks pretty simple when it comes to type 1 diabetes management. You count your carbs before you eat, you inject insulin and this all should provide you with a stable blood sugar number right? Boy do I wish.
While giving insulin to cover the carbs the body will covert into glucose in the bloodstream is extremely important, it's not the only factor when it comes to Diabetes management. Exercise plays a huge role in blood sugar numbers, it's a great way to bring a higher number down, or help keep you in your target zone. Stress tends to increase one's blood sugar numbers, as well as illness, or puberty.
But the one way I've been kept on my toes throughout it all is during the night time. No matter the basal's that we put into place at night time it seems that there is no correct 'formula' for his night time insulin dosage. Clifford's body tends to be more sensitive to the insulin during the night time, I really do not know why this is, as I haven't really researched it as much. Add into play the dawn phenomenon, which typically happens for him at least around 2-3 am, his numbers are usually hit or miss. With his increased sensitivity, if he's high, it's a horrible guessing game for the correct dosage to bring him down to a nice number. I know I have to back off a good deal of what the pump suggests at night time, but just how much, well that's another story. There is no one set number, I can't just back off .5 units and hope for the best, because I get varied results either still high or too low. (Oh yeah, did I mention you must take into consideration also if they had any activity before bedtime, as it could take a few hours to take full effect?) Sounds fun right?
What I'm left with is the job that his once vital pancreas would do. The way the pancreas works is rather beautiful. You wouldn't know it but as a non diabetic you may still have a higher blood sugar from time to time if you checked yourself. That is because the body will secret your insulin at just the right time to bring you down, but not cause you to go too low. It's in no other words beautiful. It's hard to understand this when you don't have to see the other side of a non working organ in play. But here I am left playing the part of the dead organ floating inside his body and it's a bit stressful at times.
An example of my nightly guessing game when he's high is like last night he was over 300 ( which I honestly couldn't figure out why, so I busted out the ketone meter), the pump wanted to give him 3.3 units, but woah is that a large dose at night time for him. I backed off down to 1.9 units, because the particular number 1.4 units showed up in my head (to subtract), and well I went with my instincts. Because he's corrected, I must set an alarm to get up 2 hours later to make sure he's not coming down too fast, last night he happened to be 270 something I believe, and while typically that number comes down into a more stable or target number, something in my stomach said that we should still bolus for this one as well. In fact the pump wanted to give him 1.4 units and I only gave him 0.3. The nice side of this story is, he's is sitting currently at a 117! But there are times it could go either way, it's never perfect, and it's exhausting to be in my head during these few short moments.
This is diabetes. Not what you see in books, or on the internet. It's not black and white, and while it's manageable as they say, it's not easy. It's time consuming, it's a parasite that takes from you every single moment of the day, but it's worth all the hassle to see a healthy child wake up in the morning! Just a little inside view into the life of Type 1 diabetes!