I was diagnosed with Type 1 diabetes when I was 14. I am now 45. When I was diagnosed there were no blood sugar monitors. Instead we tested our urine to see how much sugar was being “spilled.” The syringes were a little thicker and the insulin not as good as it is now. Of course insulin pumps came out about 15-20 years ago but they were not very reliable at first and who wanted to wear a pump? I hated testing my blood sugar because I got such high readings that I mostly became discouraged. So, I took my insulin every morning and when the short acting stuff came out I tried using it but I was never able to get a real handle on it so I used it sometimes and sometimes not. My A1C’s were always between 7.8 and 9. An A1C is a blood test that measures your average blood sugar over a 3-4 month period of time. Normal is 6 or below. Good control is 6-7. Fair control is 7-8. Above 8 is too high. So I was not going super high but I surely was not under control. So that is what life was like with respect to the game of balancing blood sugars. A few years ago I had about enough. I had been gaining better control after I turned 35 and made some more responsible choices in my life. I began working out. I lifted weights, I walked, I jogged, I played golf and about six years ago I began going to yoga classes. And then about three years ago I made a significant shift in one of the most important aspects of balancing blood sugars. I decided to go on the pump. Since then life has gotten progressively better. Since going on the pump my A1C’s have been between 6.0 and 6.7. That is better control. But beyond that has been the shift in my perspective toward life. Instead of feeling out of control and thinking that there is not much more I can do, I feel good. Instead of feeling negative all the time I feel much more positive about things. Instead of feeling hopeless I feel more optimistic. Instead of not wanting to test my blood sugars I want to know where I am all the time. In fact, I want to know if I am “trending” up or down. I now check my blood sugar 10 – 15 times per day. And it is my humble opinion that in order to gain acceptable blood sugar control one must check a minimum of 10 times per day. And now, I am in a position to share what I have learned with others with Type 1 diabetes. I am partners in a company that has established a not-for-profit company and they have asked me if I would lead an effort to reach out to others who have Type 1 diabetes. I believe they asked me to do this because they have seen such a profound shift in me since figuring this thing out. Granted, I am a slow learner I am sure. There are thousands of people out there with Type 1 diabetes who have figured it out and they are realizing good control. However, it is my conclusion from the reaching out I have done to date that there are a lot of people out there who have not and it is to those that, hopefully will hear my voice. For whatever reason the required information needed to become a master of balancing blood sugars is not being communicated at an effective level from the health care professionals to the patient. This is the case for many reasons but there is one pre-requisite to conquering diabetes and to become master of the game of balancing blood sugars. And that is that you must make a decision that you are 100% responsiible for your success. If, at the end of the day, your doctor is merely the person you see every 3-4 months to go over Lab Blood reports and to write your prescriptions you have arrived. You must make a decision that it is your responsibility to figure this thing out not your doctor’s. Once you have made this decision the path is easy and short: In any game there is an objective. In basketball it is to get the ball in the hoop and when time expires to have scored more points than the other team. In chess the objective is to put the opponents King in check mate. In golf it is to get the ball in the hole in the least number of strokes. The objective of the game of balancing blood sugars for a Type 1 diabetic is to mantain blood sugars in a pre-determined range. You can decide what you want this range to be. I have a range of 75 to 150. I call this my green zone. If I am in this zone I am realizing the results I want to get. I have two other zones. 70-75 and 150-200 are my yellow zone. If I am in the yellow zone I need to determine if I am trending up or down and then make some decisions relative to eating, taking more insulin and engaging in physical activity. If my bg reading is below 70 or above 200 I am in the red zone and I know I must take some action. How do you play? They primary component parts of this game are insulin, food, physical activity and current general health. I will, in the future, expand the game to include other factors but first I think it important to get the core understanding of balancing blood sugars. We need to take insulin because our body does not produce it. You should know, in case you did not know, that insulin was invented only in the last 90 or so years. So, prior to this anyone acquiring this disease would die in a relatively short time. Why would they die? They would die because insulin acts as a “key” that unlocks the door to all the cells of the body to let the glucose from the blood in. So without insulin the glucose does not get in and the cells do not get fed and the body begins to break down and soon dies. So, insulin opens the door to the cells and lets the sugar in. Too little insulin and blood sugar levels are high. Too much insulin and the door is to wide open and blood sugar levels drop too low. Food is made up of many different things but there are really two things the we are concerned with. Those are …….. How many carbohydrate grams am I consuming and How many fat grams am I consuming? Why do we want to know this? Because carbohydrates and fats are converted to glucose in the blood. Physical activity is primarily important because it burns glucose in the blood. It is important for other reasons that we will go into later. General health is important becasue it effects the way insulin works in the body. If you are overweight and do not excercise you will probably be more resistant to insulin. If you have the common cold you may need to take more insulin. If you are stressed out you are secreting hormones that raise blood sugar levels. So now that we have covered the foundational components let’s talk about the strategy. It is quite simple actually. First, you must establish your basal rate. If you are Type 1 you should either be on Lantus accompanied by a short acting insulin like Humolog or Novolog or on the insulin pump. If you are not then you are not on the best insulin therapy. The basal rate is the amount of insulin that will keep you at a steady blood sugar level while you are fasting and this is your Lantus dose if you are not on the pump. Second, you must determine your insulin sensitivity number. This is the number of points your blood sugar level will decrease for one unit of insluin. For example, if you test 4 hours after eating and your blood sugar is 200, how many points will it go down if you inject 1 unit of insulin. My number is 40. So I would need 2 units of inlusin to get back in acceptable range. Third, you need to know your insulin to carbohydrate ratio. 1 unit of insulin will cover how many carbs? My ratio is 11. So if I am eating a meal that contains 35 carbs I need to take atleast 3 units of insulin to cover it. Once you have established these three numbers then you are well on your way to mastery and conquering the blood sugar balancing game. Until next time………………