Monday, August 11, 2008

Fun with Blood Sugars

Daughter’s insulin needs are dropping. Possibly it’s because she’s lost some weight, possibly because she’s more active, or who knows what else. As a result, I’m reducing her insulin. Daughter takes Lantus, which serves as a basal insulin always working in the background, every evening. Before she eats, she takes Novolog, which we calculate based on her blood sugar and the number of grams of carbohydrate she’ll be eating.

Her changing needs make our regular challenges even harder. The workshop has very strict rules to follow. The doctor’s orders have to be very specific. To further complicate things, Daughter’s endocrinologist is very rigid. He wants her to eat the same number of carbs and calories and use the exact same insulin scale at every meal. Daughter was regularly having low blood sugars in the afternoon. The workshop was freaking out. Endo refused to change the orders for her lunchtime insulin because that scale worked at her other meals. Now I know that many endocrinologists will use different insulin to carb rations at different times of the day. Daughter’s endo won’t. I finally began telling them fewer carbs for her lunches so they would give her less insulin. It has kept her blood sugars in range and reduced the number of lows.

Most of Daughter’s blood sugars are now in range, and I’d like to fax the new numbers with the reduced insulin to the endo so he can change the orders. There’s just one problem. Daughter is running high in the morning. She is running high because she is getting up at night and eating. It could be that she is going low, and is eating to cover it. But since she isn’t checking, I can’t confirm that. I have explained to her in very simple terms what the problem is. I’ve told her she may be hungry because she’s dropping, so to check her blood sugar and then come talk to me before she eats during the night. I’ve pointed out that she feels better when all of her numbers are in range. I’ve explained the long term consequences of high blood sugars. I’ve pleaded with her to cooperate as I try to figure out her insulin needs. I might as well be talking to the wall.

So why is she doing this? She doesn’t want to have her blood sugars in range. She doesn’t think she deserves to be healthy or feel good. She gets scared and sabotages herself repeatedly, whether it’s with her diabetes or showing responsibility around the house. We’ve had many conversations about her fears and how she deserves to feel good. Sometimes those conversations work, and she’ll continue to be responsible for a few days. Someday, maybe she will believe that she deserves happiness and health and will be responsible all the time. I keep hoping.

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