JDFR Holds T1D & Me Symposium (Continued)
Q: If I get a reading of 300 mg/dl at night should I spread out the insulin delivery so that I decrease the blood glucose level at a slower rate?
Dr. Adi: In the middle of the night I recommend that people should do an extended bolus for corrections, even just 30 minutes so that the drop in blood glucose levels is a little more gradual. Naturally, the body doesn't like things to happen too fast. For anyone who has diabetes, the body's reaction to a fast drop in blood glucose levels is similar to having a low blood glucose level.
Keeping Detailed Records
Q: What level of involvement should we expect from our endocrinologist?
Dr. Adi: You should expect everything from your endocrinologist. I do not rely on the A1C. You need to look at the numbers. Your endocrinologist should look at your pump, download the data, read the data and then give you an adjustment. Children change all the time; I'm always tinkering with numbers and finding ways to improve them. Your endocrinologist should push for a CGM and then look at the CGM data. It is extremely time consuming but that is what it takes. You should have someone who knows about the physiology of your child, and then have that person teach you about the physiology of your child, about what insulin and glucose do to the blood glucose levels, and get constant feedback. However, for your part, you need to keep the records.
Q: What do you expect to see in the logs?
Dr. Adi: Almost all the information that you can get about the things that matter to blood glucose levels — blood glucose readings, what you ate, the carbohydrate content, the level of activity, your insulin boluses, what time you go to sleep and wake up, etc. Over time you will begin to appreciate the trends. I don't manage diabetes in kids; you do it. My job is to teach you how to do it, give you the tools, and give you feedback on how to improve.
Q: Is there proof that these logs and records make a difference?
Dr. Adi: I'm going to let her answer that for you. [A fellow parent turns in her seat and nods vigorously] It sounds like a lot of work, but the record keeping becomes routine quickly. Does it help? It absolutely does. Diabetes is about numbers, and if you're not looking at the numbers, you can't make the appropriate changes. Is there a specific paper from the literature that proves this? I can try to dig one up, but keeping track of these numbers is not that much work. If you monitor the data, you can see the trends yourself. We often consider a single number or single event, but the big picture, which we obtain from the logs, is much more enlightening.
* The current FDA and International Standards Organization (ISO) requirements mandate that at least 95% of points must be within 15 mg/dl of the lab value for readings under 75 mg/dl and within 20% of the lab value for readings over 75 mg/dl.
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NOTE: This information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from