Evaluating the Numbers

Diabetes is a numbers game. We are forever chasing the elusive bliss of bg perfection, a better A1c, or day of spot on carb counting. Some days the planets align and all seems okay; other days we chase highs and lows via the diabetes roller coaster. But how do we evaluate success? And failure, for that matter? For many the quarterly A1c test is the ultimate report card, for others reporting is a daily process.

I fall somewhere in the middle. I look forward to (or dread) the quarterly A1c because I like the overall picture it presents. It gives us a "big picture" idea of how Dylan is doing, and while I try not to take it as a reflection on my ability as a d parent, let's face it, it's pretty hard not to. My problem with the A1c is that it doesn't take into account what is going on in Dylan's body each and every day. It's doesn't identify areas in which pump settings need to be adjusted, or carb ratios altered.

For this information I turn to the pump data itself, and while I have heard from countless people that they hate the Medtronic CareLink reports, I quite like them. I upload pump data every 2 weeks (or that is the goal anyway) and I go through the numbers with a fine toothed comb, looking for patterns, problems, or anything out of the ordinary. Without fail, I always learn something new; no 2 uploads are ever the same. In fact, that seems to be the rule with diabetes - as soon as things start to make sense, they change.

Over the past few months, one trend emerged over and over in the reports - Dylan was not testing enough. This has been an ongoing problem for us, and the one things we are continuously working on. Dylan is amazing about testing when he's at home, but regular testing at school has always been an issue, more so as he's gotten older.

The most recent upload, however, showed quite an improvement in testing, and more tests means a more accurate picture of what is really happening inside his body. So what did I learn this time? I learned that we need to up his basal setting almost across the board. In the 2 weeks of data, only 3 days did his average bg fall into the ideal range. The remaining 11 days it was just above normal. Was I surprised? At first, but then I took into account a number of things. First, it's been a couple of months since we made any pump adjustments. Second, he's growing, and has been eating a lot more lately. Third, hockey season is over, so his activity level has decreased a bit. Each of these factors, or all three, could be causing his bg to rise.

Without the reports, or a log of some kind, I would have to wait until our next quarterly A1c test and endo visit to find out this info and to make pump adjustments. But our next appointment isn't until the end of July, so that's a full month in which Dylan's bg could be running higher than it should, wreaking havoc on his body and making him feeling like crap unnecessarily.

So now what? We tweak. We increase basal rates a bit here and a bit there, and maybe increase carb ratios a tad. And we fire the data over to the endo for any additional changes. Then in 2 weeks we repeat the process. And we do it again, and again, and again, every couple of weeks, to ensure that Dylan's pump is giving the ideal amount of insulin to his body throughout every day.