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[IP] Re: [IP] A little dissapointed with bg´s

Yvonne wrote about her 13 year old daughter, 6 months on the pump, who had
her A1c come down from 14 before pumping to a steady 10 since pumping.  She
had been expecting the numbers to get much better by this point in the pump
cycle.  Then someone said that exercise would bring down her A1cs.

I just have a couple of observations -- 13 is bound to be a time of raging
hormones, and neither Yvonne nor her daughter should beat themselves up
because the numbers are not 'better'.  Even without hormones, growth spurts,
etc., it takes many people a lot more than 6 months to find the optimal
basal and bolus settings, and judging by my own experience in the dark ages
of one-shot-a-day, urine testing only adolescence, the girl's need for
insulin will probably vary widely for no apparent reason until she stops
growing (for me, 19 or so).

In addition, if exercise makes her blood sugar go down, she can actually end
up with higher a1cs if she has to treat a lot of exercise-induced lows.  If
she's one of the people (like me, as confirmed by a CGMS test) whose blood
sugar goes up when she exercises, it can make the 'magic' number worse (not
a reason not to exercise, but a reason to test before, during if possible
and after exercise until a clear picture emerges of what her individual body
does with it).

I personally think that 4 points of improvement in 6 months is pretty darn
good, given all the variables you all are facing.  I'm not saying that we
all shouldn't try to improve our diabetic control, but it's a delicate
balancing act between encouraging a 13-year-old in efforts toward control
and having her feel guilty over something that really isn't 100%

Just my .02.  YMMV as always.

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