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Yesterday's endo and CDE appointments left me with plenty of new techniques that I'm ready to put into practice. Even though my A1c finally bumped from 7.3% (which I'd been stuck at with the pump for over 6 months) to a 7.1%, I know that I can do better. And despite the better A1c, I'm not seeing the types of patterns that I prefer to see. So here are all the tips that I'm setting into motion over the next weeks.

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I haven't realized how hectic the last week has been until tonight. School is picking up. I've had doctor's appointments and health concerns. Plus my social calendar has taken off like a rocket.

So I'm sitting down to do my averages tonight. And not liking what I'm seeing. But I'm also understanding that this may be an "uncontrollable" bump in my blood sugars.

My averages have jumped back up this week to the high 160 range. I'm perturbed at some of the results I see...like a 44 followed by a 56 or a 363 from slacking on my boluses. But I also know that some of these highs are my own doing...although I can't say much about the lows at this point.

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Despite a random weekend of highs, my averages are down from their 165 perch from the past month. My current 31-day average is 156 (weekend highs and all). And I'm celebrating those inverted numbers.

The added activity from classes has definitely lowered some of my numbers. I've had a fair amount of lows, although nothing that seems too out of the ordinary for being in control. Some are after walking to class; others are late at night after the activity of the day catches up with me.

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I'm currently on Ortho Tri Cyclen Lo, which is a low estrogen triphasic birth control. I picked this one years ago because it was low estrogen and had the same progestin that's known to decrease acne. Plus it comes in a pretty nifty diskette...mine has a flower on it in fact. I only stayed on it for six months back then though because it wasn't really helping with the cramping that I was having. Nor did my acne seem to improve.

I went back on it a few months ago because of the Accutane regimen that requires birth control use. It seemed the safest option after Seasonique left me with 21 days of breakthrough bleeding. This is my second completed pack. And I think I'm beginning to see a pattern with my blood sugars.

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My averages had been looking much better the last few weeks with the mix of keeping a stable schedule and eating a little better. I was having my usual bouts of lows (in the 50's) with the lower averages, but I was also working to correct those issues. So this week, I'm sad to report that my averages have soared back up with the onset of school.

The first week of school (or any time I get sincerely busy), I tend to let my diabetes slip. I check my blood sugar less often and at the most unusual times. I don't stay on top of my insulin, as in I let my Lantus doses fall outside the typical 12 hour range or delay my boluses. On top of all that, I tend to eat off schedule (since I'm still adjusting to the change in daily routine) and never decent meals.

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I've really been struggling with the Lantus and exercise mix. When I first started out, I did okay with a few lows here and there (nothing out of the ordinary for me). But as I added in new and different work outs and upped my intensity, I'm struggling to keep my blood sugars stable before, during, and after exercise.

With the pump, it was so easy to decrease my basal so I started my workout in the 180-200 range. I struggled with maintaining a higher level during exercise, often going low...but at least I wasn't concerned with those numbers completely wrecking my averages.

Now that I'm back on Lantus, I'm re-learning everything that I did five or six years ago (since high school held my hardest workouts). But I'm failing miserably. I can't get the range right before working out, often soaring to the 260's. And during, I'm flatlining in that same range.

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I got so frustrated with my A1c number and my recent averages that I started logging in detail again. I'd planned to start after finals (around December 14), but I just couldn't take another week or two of 200 level blood sugars. So I brought out my UltraSmart meter which logs carbs, insulin levels, and my blood sugars.

So for the past few days, I've been logging my carb intake to the best of my ability (and trying to pay closer attention to meals that I can accurately judge), every unit of insulin, and testing as much as possible. I've also been taking this opportunity to use a different carb ratio than normal, which seems to be helping. My averages are down with less fluctuation and far fewer nasty highs.

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