Thinking out-loud…

But hey, I ain’t no Ed Sheeran…

Anyway… I want tighter control. V’s last A1C of 7.9 (avg. BG of 180 over 3 months) at the end of January was a little slap in the face, after holding steady at 7.0 (avg.  BG of 155 over 3 months) for 6 months. I expected that much, as we’ve been dealing with lots of highs. V’s Endo thought that carb counting was off on our end. It’s partially true – I think carb counting was mostly OK at home but went to hell in a hand basket when kids spent a lot of time at their grandparents’ over the month-long break. Holiday eating brought more SWAG than usual, so I can see where we could have been miscalculating carbs more frequently.

Some other things were not in our control. There was a lot of sickness in December and January. Even mild crud tends to send V’s BG into stratosphere, and while we did everything we could to keep it in a good range it was often a losing battle. There may have been a growth spurt there, too.

What I have not shared with the Endo, but thought about quite a bit, is that we also got more lax with higher BG. We’ve become more tolerant of it, less focused on bringing it into a better range, taking longer time waiting to see if it would come down on its own. The combination of all of the above factors resulted in a rather big jump in A1C. Now, don’t get me wrong, 7.9 is not terrible. But it’s not great and we knew we could do better.

Both V and I walked out of that last appointment determined to turn things around. She wanted tighter control, too. We made some changes right away. We changed CGM high alert setting to 230 down from 300. I got on top of pre-blousing for breakfast.  We started paying closer attention to high BG and being more aggressive in correcting it right away.

Our efforts are paying off. Every day I obsessively check the stats and the trends in the PDM. So far the average BG for 90 days has been steadily declining, and V is on track to get a lot closer to 7.0 again. But it did not come easy. There have been more lows, some unexplainable, others direct results of impatience and rage bolusing. Good A1C due to the lows dragging the average down is not a good idea, that’s not what we are shooting for. So we are figuring out how to stay in a better range without doing unhealthy things. Or plain stupid things. We’ve been more diligent about carb counting and carb intake. V has been back to her sports, which helps to manage her BG. My husband and I have been waking up more at night to keep an eye on and correct BG.

V and I got talking about the progress and the process the other day, and I mentioned to her that if she really wanted to get BG under 7.0, we’d have to take a close look at her diet and reduce the number of carbs. Her reaction was lukewarm and it’s understandable. I don’t expect her to get onboard now and I’m not going to push it. If it were me I know I’d want to try a low(er) carb diet. But how much can I expect my 9-year-old to give up for better BG? How much of a tighter control does SHE want? It’s her life, it’s her body, it’s her diabetes (as she often points out to me). For me, a tighter control is almost like a fun challenge, a game. I’ll be honest – a good A1C bring some bragging rights that I rather enjoy. But for V, the daily headache of diabetes management sometimes overshadows all the benefits of a good A1C. What is good enough? How hard is she already working to get to back to 7.0 and is it worth it to even think about a lower A1C? How much would it push her toward burnout and diminishing returns when it comes to diabetes control? Every day I have to ask myself: who am I doing it for? And, is it worth it?

Image credit: Melissa Lee at


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