The Rebound

No, not Joseph's blood sugar-- just my attitude.

Last week was tough. Increasing one's humility quotient always is. But it's inevitable, I guess.

The nature of this disease.

Anyhow-- first off, I need to thank everyone who commented on my previous post. Your words of support -- along with your willingness to help -- meant a great deal.

More than I can express here.

Now, you people also raised many excellent points, and I was going to respond to everyone's comments in a comment. But I'm afraid that comment was becoming post-size.

Thus, this post.

{Deep breath}

Many of you gave voice to what my gut was telling me as I sat silent in that exam room.

This was huge.

For example, a number of you took issue with the whole "basal insulin needs to be at least 50% of the total daily dose (TDD)" concept.

I'm right there with you.

You see, we've done basal tests before and found that Joseph's basal insulin could keep him steady (even when making up only 30% of his TDD). Unless of course, he was very active. In which case he would need even less basal insulin.

We've never subscribed to the idea that one formula fits all. What works (or at least, used to work) for Joseph may be out of the question for many others.

But we're not trying to create something that works for all diabetics here.

Just our son.

Now, of course insulin needs change. And because they do, more basal testing is needed.

Especially since his doc raised his afternoon basals by 33%.

That's right-- 33%.

Typically, I would have taken issue with such a dramatic change in Joseph's regimen. I would have asked her to take another look at our Smart Charts -- this time, with me (as I've done at all previous appointments), showing her why this move might not be wise.

I would have pointed out other factors that might have contributed to the rising A1c (i.e., excessive highs on our recent road trip, and time disconnected from his pump during baseball games-- games in which Joseph's adrenaline was surely through the roof).

But typically, Joseph's A1c didn't move so dramatically upward.

In that moment, I felt as though I'd failed-- as if I had no right to suggest an alternative.

Well, that moment is done.

The last time Joseph's clinic set his basals, insulin-to-carb ratios, and insulin sensitivity factor was a year and a half ago-- at his pump start. Since that time, we've drawn on information from books like Smart Pumping, Pumping Insulin and Think Like a Pancreas, and tested a ton-- 12-14 (sometimes more) times per day.

But mostly, we've learned from our son.

We've seen how he responds to insulin at night (i.e., he's very sensitive-- during the day, one unit will usually bring his bg down 175 points, but at night that's way too much insulin); how his blood sugars go haywire with pizza or pasta 5-6 hours after he eats; how just 30 minutes playing catch in the backyard can bring down his bgs 100 points or more.

Unless, of course, he's just had ice cream.

You get the picture.

Further, a number of you suggested that Joseph's increased A1c could be connected to the fact that he's growing -- thus we're "aiming at a moving target"-- and that he is on the verge of puberty.

Agreed.

In fact, from where I sit it looks as though this boy is not simply on the verge of puberty-- I'd say he's in the thick of it.

{Heaven help us}

So what am I saying here?

Well, I'm still feeling overwhelmed. Still coming to grips with the fact that Joseph's bgs have been drifting upward and that we may not be able to gain significantly better control until he's through puberty-- (though, that doesn't mean we won't try).

Still damn scared of what all these highs might mean for Joseph down the road.

And still just trying to figure out the numbers-- knowing that what we figure out will be lousy with caveats.

But unlike last week, I feel like our best just might be good enough.

And really, it has to be.