The primary goal in managing diabetes is to achieve blood sugar levels as close to normal as possible. There are several subgoals:
1. Achieve primary goal without experiencing too many lows. Lows are blood sugar levels that drop below, let’s say, 75 mg/dl.
2. Achieve primary goal without experiencing much time in the high blood sugar area. High blood sugar is, let’s say. 240 mg/dl to 300 mg/dl. Anything over 300 is an emergency situation in my book.
3. Achieve primary goal and be able to eat well and satisfy hunger needs. This can mean several different things for each individual.
4. Achieve primary goal and be able to live an active and purposeful life. Again, different strokes for different folks.
Normal blood sugar’s range for a human body is between 80 mg/dl – 120 mg/dl. It may, at one time another, fall a bit below or rise slightly above. However, normal 4 hour fasting blood sugar should be around 80-100 and at most 120. Type 1 diabetics do have an opportunity to stay in the normal range for hours at a time. Some may be able to extend that for a few days. It takes great skill to achieve normal range for hours at a time. A Type 1 diabetic’s blood sugar will rise many more points after eating than a person without diabetes. That is why the upper limit of the goal’s range is 240. And the Type 1 diabetic is always in danger of falling too low. Blood sugar monitors enable us to “check” our blood sugar. Checking is just that. It is a moment in time. Multiple testing over short periods of time will reveal trending. Trending and the rate of trending is critical information to the ongoing management of the disease. A1C blood tests provide the average blood sugar over a period of 2-3 months. An A1C result of 6 represents an average 3 month blood sugar of 136 mg/dl. An A1C result of 7.0 is an average blood sugar of 172.
To redefine our primary goal.
TO ACHIEVE A1C RESULTS BELOW 7.0.
Scientific research has shown that if a Type 1 diabetic can continually achieve A1C results below 7.0 then the risks of complications decrease by 75%! Remember, the quality of the 7.0 or below result is connected to our achieving our subgoals as well.
Ok, so we have one side of our equation. An equation is a mathematical statement that asserts the equality of two expressions. We have defined one of our expressions. It is the results or goals we desire to achieve. So far are equation looks like this –
A1C results below 7.0 while achieving all of our subgoals = ????????????
The “=” sign is what separates our expressions. What is the other side of our equation? Well, first, let’s look at some simple equations that most of you are familiar with. By the way, if you are diabetic or assist others who are diabetic, it is important that you understand some math. Insulin delivery, carbohydrate counting and accounting for other factors are mathematical expressions.
2 + 2 = 4. Ok, that is an easy one.
2 x 5 = 10. Hmmmmm
20 – 3 = 17
10(2 + 7) = 90. Now, if you are still with me then good. Because the other side of our equation has a bit of all of this and more.
The other side of our equation is a bit complicated and involved. The diagnosis of Type 1 diabetes means that a very critical system of the body has been destroyed. It does not work. It is a single point of failure to the entire body. Our task, which we are working on expressing in an equation, is to rebuild that system, monitor it 24/7 and manage it. Side note: if you are reading this and you are a type 2 then hang in there. Your equation is the same on one side but completely different on the other. However, if you don’t get on it you will soon be a type 1 or dead.
Ok. We are going to go step by step. Let’s redefine our desired outcome one more time:
Achieve A1C results below 7.0 while minimizing our lows and highs, feel good and do things we desire.
In order experience this outcome what must we do? Well, most people upon a diagnosis of diabetes first encounter medical professionals. Some of us meet the paramedics first, then the emergency room staff. There are always a lot of nurses and then “The Doctor.” The Doctor. The first order of business is to get stabilized. This usually means a short hospital stay. As stabilization is achieved then we may meet a Certified Diabetes Educator and a Dietician. We are introduced to insulin, needles, blood glucose monitors, test strips, finger pricks, carbohydrate counting, glucagon, affect of physical exertion on blood sugar levels, emergency scenarios. I will stop there for now. There is a lot and this is just the beginning. I was told by my doctor 34 years ago when I was diagnosed – “Michael, you just need to take your medicine(insulin) and watch what you eat and you can live a normal, healthy life.” LOL. My point here is to let you know that 15 minute doctor visits every three months will not get you close to where you need to be with this disease. There are diabetes management courses out there that are very good and you can get a lot of information and skill development from them. I highly recommend going through one of them. I attended one called “Mastering Your Diabetes” from the Diabetes Research Institute in Miami. It was 5 full days and it was well done. These courses will provide you with the fundamentals of the other side of the equation. What I will provide you here is an expanded expression. An expression that will not only yield A1C levels below 7.0 but will also put you on a path of transformation that this condition demands. It is my expression. My health care providers have become guard rails for my journey.
Step One: First things first here. The missing ingredient for a type 1 diabetic is insulin. Our body stopped producing it. Got to inject it. Today there are insulin pumps. This equation requires that you are delivering insulin via a pump. If you are taking injections then read through this but, in my opinion, you should be on the pump. Now, I know there are several reasons out there not to be on the pump. In my opinion 99% of them are not valid. Let me clarify, the superiority of pump delivery versus injections is so much of difference that 99% of the reasons do not hold water. Remember, the desired outcome or rather the other side of the expression is A1C levels below 7.0….., I could not get there while taking injections. I can get there using the pump. There are 3 parts to insulin delivery that you must achieve command over: 1.) basal rate, 2.) insulin to carb ratio and 3) Insulin Sensitivity Factor(ISF). Once you have command of these three components of insulin delivery then we are well on our way.
Step Two: You have to eat. And because what you eat turns into glucose in your blood you must know what you are eating, how it will affect you and how much insulin you need to “cover” it. Diet is critical for any human being. Part of the reason that there is an epidemic of diabetes in our society is because of the rich diet we eat. This is much more true for the occurrence of type 2 then type 1. So eat well. Educate yourself. Limit what you eat. What I mean by this is that, in my opinion, when it comes to eating, less is better.
Step Three: I will continue with the next steps in my next blog post. Until then be well.