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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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When the lows hit last week, I was frustrated. I'm desperately trying to lose weight and get my blood sugars in range without dropping to one extreme or soaring to another. So I lowered my insulin by one unit. The Lantus at least. Humalog stayed the same.

I've been pretty consistent with walking every day or at least every other day. I'm also using the hand weights and just generally trying to stay more active (taking the stairs when possible, not parking super close to the store/office, etc). My food intake has stayed the same where I eat a normal breakfast, a low carb/calorie lunch, and usually a normal dinner. I try to make healthy choices on a regular basis, but I do splip on occasion.

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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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I've been having way too many lows for my comfort level lately. But I've yet to change my insulin. Why? Because I'm worried that lowering by just one unit will send me back into the 200s or that it'll be the Humalog and not the Lantus that needs adjusting. Or both.

Since I've started doing a yoga class twice a week and doing twenty minutes on my own at home, my blood sugars have been in the trenches. My averages have dropped, yes. But I'm having too many lows in the middle of the night, too many after I've just eaten, and too many below 70 that I don't catch early enough.

The other night, I had a snack before bed but didn't bolus for it. I just didn't feel like it and I wasn't sure I really needed more insulin in my system. I expected to wake up in the 200s and I was okay with that. But around 6am, I woke up with weak knees, a knotted stomach, and sweaty sheets. I had already dropped to 52.

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I don't remember worrying about sugar, except at Christmas time when my family would send sugar free candy that tasted horrible. However, I vividly remember the day I officially learned to count carbs. It was an "Insulin Intensive Management" class that focused on insulin to carb ratios, lowering A1c's, and reading labels correctly.

My dad and I both attended with several other kids and their parents. It was in the same office as my regular endo appointments. The nurse was new, different, not so exciting. I don't recall being thrilled to be there.

We started out with some "pretend" foods like pastas, vegetables, and pizza. We put together meals, counting the carbs and calculating our insulin needs. Reading labels was a breeze. Even calculating was easy. Carb counting was for the birds!

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Sometimes I really wish that the pump would work for me. Sometimes I wish that my A1c didn't go up and I hadn't had so many issues while on it. I wish that I could stand wearing it 24/7, having tubing and infusion sets all over me. I wish that those infusion sets didn't cause such horrible rashes or that the repeated use of them wouldn't create unsightly bumps.

Right now, I wish all that. Because I've woken up the past four mornings under 70. This morning, I woke up at 52. And that isn't okay.

Part of the problem is that I'm bolusing for late night snacks. Although I'm keeping the boluses under two units of Humalog, it's obviously too much in the mix of Lantus peak. But if I don't bolus for the snack, then I soar into the 200s easily in the middle of the night.

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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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Yesterday I bought a tiny notebook and began my new logging routine. So far (even though I'm only two days in), I've done pretty good with keeping track. I've settled on logging the time, blood sugars, both Humalog and Lantus insulin injections, low treatments, and any strange foods (like a chocolate shake).

I haven't noticed any trends, but then again I'm only two days in. The biggest thing I've noticed is that I jump high after most lows (my habit of overtreating). I doubt that I'll stop overtreating so I think the best way to handle that is to judge my insulin after the lows more accurately...which means actually thinking about the carbs and low combo instead of just (under)guessing on the dose.

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I usually keep a pretty basic logbook. I record every blood sugar based on time along with my Lantus injections, workouts, sickness, and any abnormal food choices (like pizza or chocolate shakes). I circle anything that's above 250 or below 70 and try my hardest to put some comment to the paper. I average by day and by time of day with an overall ending average for the week.

I don't do it everyday. At least twice a week, I sit down with it. I record it all then stare for a minute, an hour, whatever to see patterns or necessary changes. It keeps me aware. I can see how certain things are affecting me, if my Lantus is adequate, if my medications are making a difference. It lets me know where I stand in this whole diabetes management thing.

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