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After the picnic last night, I was extremely tired. It'd been an incredibly long week, we'd just played all kinds of games, and to top it off my blood sugar was low. So I ate some fruit and mixed nuts hoping I wouldn't have to eat anything heavier right before crashing into my bed. But my blood sugar wouldn't come up, it seemed to only be dropping. I drank juice and ate crackers, intently watching the CGMS to tell me when it was rising.

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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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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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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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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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Lowering my A1c is my diabetes priority at the moment. I'm ready to bump down from the 7.3% that I've been stuck at for the last six months. I'm looking to get back under 7% and head towards 6.5% to achieve another "lowest A1c of all time." But today it hit me that lowering my A1c is really taking a toll on me.

Not only is it increasing my diabetes stress to do everything right (or at least the majority), but it's also creating a domino effect with quite a few other aspects of my life. Things that are "tolerable" but when combined make me wonder if it's worth it. I feel like I'm always in a state of "weighing the consequences:" do I try harder to lower my A1c or do I tolerate the 7.3% and avoid the ill effects?

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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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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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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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