After six months of trying, I've discovered that achieving tight BG control is not simply a matter of counting and covering the carbs my daughter eats. I need to learn how her body reacts to various carbohydrates and various times of the day. This seems like a complicated task because of the many variables involved! How can I isolate what factor is impacting her BG levels at any given time?
Unfortunely (and frustratingly so)....you simply can't. But wait! There's still so much you can do to improve BG levels and determine trends! Your daughter may have different insulin to carb needs throughout the day. For example, someone might need 1 unit per 15 grams of carb for breakfast, but only 1 unit per 20 grams of carb for lunch (when they are more active). Adjustments in basal insulin may help throughout the day as well, but this can only be achieved when using an insulin pump. In my experience, there are individual responses to carbohydrates as well. You will pick up on these. I have some patients tell me that they are particularly sensitive to certain carbs, and require more than their customary dose of insulin to cover for those foods. To minimize such responses, try and make meals a mixture of carb (high fiber and less refined is best), protein and fat.
So many variables other than carbohydrate affect BG, such as physical activity, stress, illness and infection. These are very difficult, if not sometimes entirely impossible, to predict. The best weapon against BG fluctuation (and by far the best way to gather information) is CGM (continuous glucose monitoring). Research proves that you would have to do a fingerstick every 20 minutes to detect the mysterious trends you are asking about. That's where CGM comes in. CGM provides the user with a real-time glucose reading every 5 minutes and reveals important and valuable trends. CGM is a very flexible technology as well, as you can use it to detect trends and "tweak" basal rates and boluses, then reserve it for sick days, vacations, etc. However, reasearch shows that it is most beneficial when worn all the time - so that you're able to respond to lows or highs BEFORE they happen.Think of it as GPS for BG! Two CGM systems are currently available in the United States. The Dexcom Seven Plus CGM system is a "freestanding" system, although it is in line to be the CGM used in both the Animas and Omnipod insulin pumps. The Medtronic Revel insulin pump offers a CGM (sensor), and is the only pump in the United States to do so. If you're interested in learning more about CGM, here are some links:
There are also two books that I recommend:
"Think Like a Pancreas" by Gary Scheiner, MS, CDE
"Pumping Insulin" by John Walsh, PA, CDE and Ruth Roberts, MA
As always, work closely with your endocrinologist and be sure you're seeing your diabetes educator on a regular basis. Do you know much about carb factoring vs. carb counting? Results?
Can you explain?
Carb "factors" are otherwise known as an insulin-to-carbhohydrate ratio. Your carb factor is individualized to your specific needs. It reflects how many grams of carbohydrate is covered by each unit of rapid acting insulin. Example: Someone may take one unit of rapid actiing insulin (Humalog, Novolog or Apidra) for every 10 grams of carbohydrate they consume.
Carb "counting" is simply the act of accounting for the carbohydrates in a meal or snack to be consumed. Food labels, scales, and measuring cups can be used to carb count. One portion/serving of carbohydrate is considered to be 15 grams. This is equivalent to approximately 1/2 cup of many common carbs, such as corn, potatoes, many fruits and ice cream.
Can you suggest some 15g snacks w/ a good balance of carbs, fat and protein? (Something good to maintain (not spike) blood glucose overnight?)
A mixture of starch (1 slice bread, 6 crackers) or fruit (1 small banana, 1 small apple) with either peanut butter or cheese are quick and simple snacks. There are also many breakfast and snack bars that can be found that offer a mixture of carbohydrate, protein and fat. One such bar, made specifically for diabetes, is called "Extend." It comes in several different flavors, and has approximately:
20 grams carb
5 g fiber
1 g sugar
4 g sugar alcohol
The Extend Bar uses uncooked cornstarch, which is slowly digested and proven to assist in stabilizing blood glucose levels over an "extended" period of time - pun intended!
How often should you check your blood sugars? Example: If my son has a snack and checks his blood sugar and takes insulin for the snack and any correction, how soon after that does he have to check his blood again if he wants to eat more? Does he have to keep checking within a 2 hour time period? Every 30 minutes? What do you recommend?
Ahh! If only there were a clear cut answer! Each person with diabetes is different. The answer to your question depends on how long your son has been diagnosed, his current insulin regimen and blood glucose control, and activity level, to name a few. While it's appropriate to take insulin for all carbs consumed (unless blood glucose is low), do be careful not to correct for high blood glucose consecutively/too often. Although rapid acting insulins act quickly, they do remain in the system for 4-6 hours. Correcting more than once within a short time period can lead to "stacking" of correction doses, which can lead to a low blood sugar.
Work with your endocrinologist to maintain a program of monitoring and management that is just right for your son, and meet with your diabetes educator on a regular basis, and as needed when issues/questions arise.