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Practice makes near perfect at bedtime

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October 28, 2016
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Old Dog, New Tricks

I'm always amazed when I hear how much time quarterback Peyton Manning puts in at practice. More than 15 seasons playing NFL football at the highest level and he still finds areas in his game that require fixing.

It's been 10 years for us in the game of type 1 diabetes and I still have so much to learn.

Not to compare my diabetes management success to Peyton Manning's football success. If anything, I'm more like Peyton's brother, Eli. I scramble around clumsily. I get sacked. I sometimes lack accuracy. I fumble. I lose the ball. I look frustrated and dejected. And I lose (to diabetes) often.

Following our latest appointment with our nurse practitioner and a pump expert, I'm feeling pretty inspired to make some changes and teach this old dog some new tricks.

Here are a few things I’m anxious to put into action right away:

Hockey highs - We all agreed that something had to be done to counter the adrenalin that affects Charlie's blood sugar when he plays hockey games. Interestingly, he doesn't go very high during practice, but when the stakes are raised in a real game setting, he skyrockets. The plan is to start with a 10 percent temporary increase in basal insulin beginning one hour before game time and then reversing course after the game by decreasing basals by as much as 60 percent for several hours. If high after the game, we will only give half the correction - allowing the adrenalin effect to leave his system and considering the potential post-activity lows.

Dual-wave bolusing - We have not used the insulin pump to its full potential. I want to change that. I'd really like to start by being more aware of the foods Charlie is eating and remembering that the dual wave could be a good option for certain high-fat or high-carb meals. We may begin attempting a dual-wave on meals that exceed 70 grams and other meals that appear to be slowly digested. After Charlie's appointment, we had our traditional lunch across from the hospital at Au Bon Pain. He had an egg, cheese and bacon sandwich on a croissant, a bag of potato chips and some chocolate-covered almonds. It all totaled about 80 carbs. I gave a regular bolus for the meal and he spent the rest of the afternoon with high blood sugar. Maybe a dual-wave would have resulted in better numbers.

Timing - I hate that Charlie often goes very high after meals and it sometimes takes a full two hours or longer before he finally comes back into range. Does it have to be that way? Although our Novolog works fairly fast, it doesn't come close to the fast action of insulin produced by a healthy pancreas. To blunt some of the post-meal spikes, we will attempt to bolus about 15 or 20 minutes before Charlie eats so that the insulin has a head start and starts working at the same time as his digestive system.

Let’s do this! Now I just need some cheerleaders.

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