So yesterday was my son's endo appointment. He was so nervous he could barely contain himself. And you must understand, that is not at all like him.
But over the last year, his A1c has been steadily climbing. It hasn't been due to teenage rebelliousness or anything like that. More like teenage "over-scheduling-itis." :-) He's a very responsible kid, but he's carrying a heavy load in school, he's working, he's involved in church and sports, and he's just got normal "kid" stuff to do. Diabetes sometimes is lucky to be thought of at all.
But two 9+ A1c's in a row were enough to really get his attention. After his last appointment, we made some adjustments to his basal rate and his insulin to carb ratio. He committed to doing more testing—especially after meal testing. And our Doc really emphasized that bolusing 10 minutes before eating is essential to bringing down the A1c.
Well, for the last three months, my son has done "a little" more testing. But he's been quite diligent in giving his insulin as close to 10 minutes before he eats as he can.
Well … yesterday, the nurse took FOR.EV.ER to bring in the A1c results. My son squirmed like a little kid as we waited and waited.
Then the nurse poked her head in with a big smile and handed him the A1c sheet. 7.8!
I though my son was going to get up and dance! He was so thrilled. And when the doc came in he was so great too. He was genuinely happy for my son's turnaround. But then he gently reminded him that he can do even better.
He looked at the print-outs from the tester and observed that instead of a good systematic approach to testing, it looked more like "whenever the mood strikes" testing. :-) He gave a suggestion that I thought was pretty great for a teenager. He suggested that once a month, he have a "hell week" of testing. Test 7 or 8 times a day for a week. Get all the data you need to see if your pump settings are where they need to be. Then go back to normal testing for the rest of the month.
Oh, yeah, and kdroberts, I did remember to ask about a reference on the study he told us about last time. He had told us that bolusing 10 minutes before meals was shown to lower A1c by 1%. So I asked where I could read the study. He said he heard it reported at one of the national meetings and that as far as he knew, it hadn't been published yet. He said he'd let me know when he saw it published somewhere. But our experience certainly confirms the finding. My son saw almost a 1.5% decrease.
So the bottom line is: for those on insulin, make sure you're taking your fast-acting insulin 10 minutes before you eat. It really does make a big difference.
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