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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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For several months, a bunch of us have taken part in Wednesday night Diabetes Social Media Advocacy (#dsma) chats on Twitter. Run by Cherise Shockley, these sessions are about an hour long and cover a number of predesignated topics ranging from support groups to diabetes-related conferences to relationships to insurance issues. A week ago this past Wednesday, talk centered around the glycosylated hemoglobin (HbA1c) test: how important it is (or should be) in determining our treatment, how accurate it is as a measure of our diabetes control, whether or not we consider current best-practice A1c goals to be realistic or not (and why), and what sort of self-treatment we use to achieve (or try to achieve) those goals.

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Dear Metformin,

It has come to light in the last week that you have developed a couple of rather unacceptable behaviors over the last few months, and due to my strict zero-tolerance policy for medications that cause me problems, I must inform you that your services are no longer needed here. To put it bluntly, You're Fired!

When you were first hired about a year ago, you did your job well.  You helped me maintain fairly decent blood glucose levels, and assisted in the lowering of my A1C numbers.  And the side effects that several people had warned me about never appeared.  All was going well until about three months ago, and then you changed.

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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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I'm a type 1 insulin dependent diabetic. I have been since I was 4 years old. I also have polycystic ovarian syndrome (PCOS for short)...along with endometriosis if you really want to get detailed. The PCOS didn't pop up until 2006 when things progressively got worse.

Sudden weight gain, mood swings, fatigue, pelvic pain, very irregular periods, acne, male patterned hair growth, hair thinning, ovarian cysts, and increasingly difficult blood sugar swings.

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I had my second appointment with my endo today. The first was back in late June when my A1c wasn't anywhere close to where I'd like it (clocking in at 9.1%). Today's appointment went well and I'll know my latest A1c in a few days. The doctor feels like it should be down and to keep trying to do what I'm doing with a little extra help.

She is the kind of doctor who offers advice if needed, but ultimately understands that diabetes is a very individual disease and my management may be different than others. She does not seem to be concerned with higher A1cs, which is a little troubling as I know the best A1c is certainly not in the 8 or 9% range for a 20-something year old.

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Since I changed my endocrinilogist last year, I've really been happy with my experiences with Dr. K. She's the kind of doctor that means business but doesn't come off as if she's judging you. She tells you what she thinks, but leaves it up to you what to do. So usually, I'm fairly excited (yes, I said excited) about going to see her. Even when I know I've been doing 85% of things wrong.

This appointment didn't feel that way though. I just really didn't want to have to go. I've been making some changes and my averages are down. I didn't want to hear that I'd been doing this and this wrong, even if she does leave off the judgement. I just wasn't willing to expose all those mistakes to the light.

And I feel torn between wishing I would have canceled and being excited about the outcome.

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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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