Week 85 - Dec 12, 2009

Figures:

week 2 December 09:
BG 90 days average: 130.3 - A1c from BG: 6.3% - A1c from lab test: 6.4%
-That's correct, ONE point down-
Total BG tests: 477 - 90 days average: 5.3 tests a day
Bolus insulin shots: 265 - 90 days average: 2.9 shots a day
Average Bolus corr. per day: 10.9 units x 15 = 163 grms Carbs per day
NPH insulin total units per day average: 30.4

Last post we committed to tighten up controls, because A1c had jumped from 6.8% to 7.4%. Well, no diet as usual, with a bit better control now A1c is down to 6.4%

Week 74 - a1C from the lab - Sept 14

First the figures:

week 2 September 09:
BG 90 days average: 132.9 - A1c from BG: 6.4% - A1c from lab test: 7.4%
Total BG tests: 400 - 90 days average: 4.4 tests a day
Bolus insulin shots: 274 - 90 days average: 3.0 shots a day
NEW LINE: Average Bolus corr. per day: 13.4 units x 15 = 200.8 grms Carbs per day
NPH insulin total units per day average: 29.2

week 2 June 09:
BG 09 days average: 132.4 - A1c from BG: 6.4% - A1c from lab test: 6.8%
Total BG tests: 388 - 90 days average: 4.3 tests a day
Bolus insulin shots: 263 - 90 days average: 2.9 shots a day
NPH insulin total units per day average: 23.6


Now the conclusions: HUGE difference between the lab's A1c and the 90 day average. Last days the BG average was climbing steadily (travel, uneven meals, etc.), I think that this climb, plus perhaps some unchecked time spots (like 3 PM and 3 hours after dinner), might account for the difference.

Until next A1c we are adding two extra checks, one at 3 PM (we were doing 12 PM and 6 PM only), and the other at 2.5 hours after dinner.

Plus, we'll be a bit more aggressive on vial changes: we already had 2 -two- vials that even being within expiration date where not correcting, the first one we were slow in changing it (blaming a few things before the vial itself), the second one we were slow as well (cannot be the vial again!). Anyway, end result we had twice a couple of days struggling with stubborn highs.

Other than the surprise of the A1c at 7.4% after 3 months with the usual averages (see graph), no other events worth of comment. No colds, no sickness, life as usual. So, we'll do a bit more controls (to see if those missing checks are that important) to see if we can lower the next A1c.

We might do a half way check to see if the tendency goes the right way. that would be end of October (45 days after the last A1c).

Already updated - September 20th or so

Just to avoid wasting your time visiting and seeing no news, I'll be posting -say- every 3 months, when I have the latest A1c values. Next post is due then by September 20th or a little after (depending on when the data reaches my hands). The little yellow mark at the bottom of the chart, is the day of the last A1c (6.8%).

So far from the last post the BG average is:
- 10 days 121.
- 30 days 121.
- 90 days 128.

There were a couple of "eat as you please" birthdays parties with lousy correction (no correction at all in one of them, insufficient correction in the other) where I thought the BG meter would blow in pieces, but to my surprise it was just around 330-340. Corrected with 4 units of fast acting, 3 hours later back in the 65-100 range, and staying there as usual. Those were the highlights of these last 3 months.

I add here the last chart , which will be updated in the next post. I'll be deleting this post, as it'll be redundant when next (permanent) one comes on line.

Week 64 - More figures. Almost a year now

First of all, we made the A1c, so I'll post the figures for June:

week 2 June 09:
BG average: 132.4 - a1C from BG: 6.4% - a1C from lab test: 6.8%
Total BG tests: 388 - 90 days average: 4.3 tests a day
Bolus insulin shots: 263 - 90 days average: 2.9 shots a day
NPH insulin total units per day average: 23.6

week 2 May 09:
BG average: 139.1 - a1C from BG: 6.6 - a1C from lab test: Not done yet
Total BG tests: 389 - 90 days average: 4.3 tests a day
Bolus insulin shots: 223 - 90 days average: 2.5 shots a day
NPH insulin total units per day average: 20.0

- Some conclusions: The month between week 2 of May and week 2 of June, looked like we got BG down a bit more. However, A1c did not go down as much as we expected. 6.8% is an average of BG of 144. We have to consider also that he's growing, that ADA recommendation is less than 8%, and he's been eating like any other kid in the block. Next post I'll run a full year comparison.

Week 60 - Some figures so far

First of all, next posting is going to be after July 1st. So no need to drop here until that date, there'll be no news, then I'll publish the latest a1C.

Now a few numbers to see bottom line results - averages are from the 90 days prior to the date:

week 1 Nov 08:
BG average: 128.8 - a1C from BG: 6.3 - a1C from lab test: 6.5
Total BG tests: 375 - 90 days average: 4.2 tests a day
Bolus insulin shots: 122 - 90 days average: 1.4 shots a day
NPH insulin total units per day average: 16.3

week 3 Mar 09:
BG average: 137.8 - a1C from BG: 6.6 - a1C from lab test: 6.7
Total BG tests: 383 - 90 days average: 4.3 tests a day
Bolus insulin shots: 218 - 90 days average: 2.4 shots a day
NPH insulin total units per day average: 21.4

week 2 May 09:
BG average: 139.1 - a1C from BG: 6.6 - a1C from lab test: Not done yet
Total BG tests: 389 - 90 days average: 4.3 tests a day
Bolus insulin shots: 223 - 90 days average: 2.5 shots a day
NPH insulin total units per day average: 20.0

I'll post the same number once we get done the next a1C test, by the end of june.

Week 57 - Back to our life's routine

After the last post, we took a vacation in the US.It was a junk food raid. Basically we let "the kid be a kid". Though we were not particularly proud on how we were dealing with compensations, the BG was between 100-130 or so. Then we had a couple of months -we were back home, school started, and so on-, and we tried not to overly change the slow acting doses, and BG average was (February-March 09), between 120 and 160. We had an a1C done by March 20th, and it showed 6.7%. Worst than last time (6.5 %), but considering the vacation and the months of adjustment (back from the long trip in the US), not too bad. In fact, the endo was quite happy with the value. Now, since April, with slow acting at the same dose (11 of NPH for the day, 12 for the night) and the standard Carb corrections (avrg. 10 to 15 units of fast acting per day), the averages for BG are: 10 days avrg., 114.6 - 30 days avrg., 125.5 - 60 days avrg. 136.1. Again, no special diets here. Just food every 3 hours, control, and normal compensation for the carry over of the previous control and for whatever he might eat at the meal. In June we'll get another a1C done, we'll see there how this average reflects on the value. By then I'll do the next post. In short: BG averages rather decent, only one very very bad hypo episode in February (I think we over compensated, then there was a while with no meals) that scared us a lot, BG at 26. Since then, when we need to compensate more than 9-10 units, we split the compensation like 6-7 units now, the rest one hour later. That's working very well. Anyway, after that episode, no hypos episodes at all, he goes low every now and then to 40 (very few times at 35) but this is about the time when his due for food, so no issues there really. For the hyper, the worst peak in the last month was 284 (twice), and some 15 times above 200 (we make 4 measurements a day), which is an improvement since 3 months ago, were we had a few excursion up to 450. Not a lot, but a few. Anyway, I enclose the BG 10 days average measurements for the last 30 or so days. Day 365, is one year after the diagnosis.

Week 36 - So far in a nutshell

I'm back. I've been a bit busy (moved house, schools changed, business trips, etc.) and I couldn't find the concentration to sit down and write. However, for the benefit of our selected public, I'll put what has happened so far in a nutshell -and it's all good-:

1) A1c: When diagnosed, 12.1% - When treatment was initiated, 8.5% - 3 months later, 7.1% - 5 months later 6.5%. We are not doing a low carb diet, we just count carbs and compensate. Intake is at least 150-200 grams of carbs per day as we are told they are critical for growth. Diet includes pizza and icecreams, and other than the nuisance of injecting after the meal and spacing the meals 2-3 hours -to keep better control of the BG measurements and allow the insulin to act-, there are no substantial differences with the other kids diet. Yes, no candies or cookies in between, only at fixed times.

2) Blood glucose: Mostly on the low side, occasionally going high: we measure 4-5 times a day, and some four measurements a week will go over 200, one over 300, the rest between 50 to 150. Some lows also, but they can be traced to us overcompensating with fast insulin. Following the regular schedule, we had no longer hypo episodes, not a single call from the school, no worries when he goes to bed. The last 2 weeks of treatment there was no physical activity (PICC line in place), and we had to put a lot of extra insulin, but after that we went back to normal.

3) We just made the second set of infusions in December. This time we've put the PICC line and it went more than smooth. In a previous post I've said that I was not too hot about it. Well, of course, I was a bit concerned with general anesthesia, but after my 3-4 hours of concern, the boy enjoyed some 15 painless days, with no need for needles at all.

4) Insulin intake. For basal (slow) insulin, if physical activity is there, 20 units a day. Without, about 30. Compensation with fast insulin still at 1 fast unit for 15 grams of carbs. Doing the dose/weight ratio, we are yet at 0.5 to 0.8 units/kgr. Physical activity makes a big difference here.

5) A word on the people of Research Dallas (the center where we are doing the infusions): SUPERB is an understatement. If you want to understand what personal, compassionate medical care and concern means, you have to see them at work. I won't say more, otherwise it'd be several pages of praise.

Conclusions: For what I've talked with other parents, it seems we are having a way easier time keeping the right values of BG. A1c, which is critical to preserve his body in good shape, looks rather good without having made strong diet adjustments . And we've really forgotten the stress of the lows. No effects of the treatment were noticed throughout all these months. There was one cold that got him real hard, and kept him in bed for a week, but I cannot trace it as a direct consequence of the treatment, though I've dutyfully reported it to the brains behind the operation.

I'll wait a little while for the next post, to see if there are some news after the second set of infusions, or if things keep doing the same.