I started responding to a comment on my last post "Like a game, but not." when I realized I was breaking into another post... well more of a sequel or update.
I think at best we get about a week of "stability" from time to time. It's been a while since we've gone 72 hours without a correction. I went into our last appointment convinced that he was going to be well out of range and he was spot-on center (for 4 years old, they targeted his A1c at 9.0%, and he was exactly that). But again now I see numbers bouncing around with an overall upward trend.
We made the adjustment to the long acting last night (only 1/2 unit, thank God) and he was sent off to bed at 6.7 (120) 2 hours after dinner. Most often at that level he trends up; not last night. At dinner +4 hours he was 4.0 (72) - juiced him (13g) and he was 8.1 by 11:00 and a smidgen higher at 3:00, 8.3 (150)... beautiful! 7:30 this morning, back to 4.1. *Insert multiple expletives here*
Jonathan's been really into oatmeal for breakfast lately, not bad, healthy choice. He also like a little chocolate syrup in his milk - OK not so great, but he eats well over all. Now back to 4.1, kid needs to eat NOW. I do the math: oatmeal + milk + chocolate = 52g @ 1:13....4 units.... Hmmm... Let me think about this for exactly 4.1 seconds, because I can't make him wait too long, but I need to decide what to do about this. The cheat sheet says "if less than 4, dose after meal with 1 unit less". So at 3.9 it's 3 units after, and at 4.1 it's 4 units before. That seems like a huge gap for a 0.2 mmol/L (3.6 mg/dL) difference. Hmmmm....
Being that he's with me all morning, I go for the 4 and test him 2 hours later at snack time: 19.1 (344) *Insert multiple expletives here*
On one hand I'm glad I didn't short change him after all, but on the other it could have gone the other way too. On weekends I'm a little more apt to be on the aggressive side with insulin; school days I do a 180 and go conservative. Today it seems I did the right thing so far.
Next stop on the glucoaster, Lunch!