Impromptu Picnic

We decided to do an impromptu picnic at a state park and go swimming in the river. We had brats, zucchini bread, pork rinds with ranch dip, Quest protein chips, pickles and sauerkraut. Great BG all day... my black bag with Samuel's diabetes supplies was always close. The kids swam and played for 4 hours and Mama got some much needed sun.

Only downside is we lost ANOTHER sensor today from being in the water so long. We put on a new sensor when we got home - this makes #3 in 6 days! I called Medtronic and fortunately they're replacing the 2 from earlier this week.

Non-Communication

When Mommy & Daddy don't communicate. Yup, we're human.

Zucchini Bread

Delicious, moist, low carb zucchini bread.  Can easily be made into muffins.  One of my kids favorites!

 

A1c History

Simply logging his A1c's and growth. Converting this into a chart for a visual.

Weekly Averages

At the end of each week, I enter the averages you saw on the BG Tracking Log (previous post) on this sheet (yellow). 

I also pull reports from Carelink (his Medtronic CGM) to get BG averages and Standard Deviation of actual finger pricks (green), and Sensor averages and Standard Deviation from his CGM readings (blue). I then average all of those to come up with what I feel is the truest BG and SD averages.

I'm also logging key notes so I can refer back to growth spurts, sickness, etc to see if I handle them better as we go.

BG Tracking Log

Someone PM'd me the other day about how we log Samuel's info. There isn't a right or wrong way - whatever works for you. Some people use basic pen/paper. Some use apps. Some use nothing. I use Excel.

I will admit that I take logging to the extreme. This isn't for everyone. I'm proficient in Excel because of my work, so this just makes sense for me.

This is our "main" log. It's open on a tablet sitting on the kitchen counter 24/7. You can see I log every finger prick, if I gave glucose/carbs, when gave a bolus and how much, what he ate, etc. I am constantly looking at 3 days - yesterday, today and tomorrow. You'll notice yesterday right before lunch he dropped a bit, so I entered right then what his bolus would be for breakfast today (lowered the Regular a bit). Today he still dropped before lunch, so if you look at tomorrow, I've already entered what I plan to do for his breakfast bolus. For close to a week he's gone high in the middle of the night so I upped his basal a quarter unit last night (that's why it's yellow - to indicate a change)and I've already entered what I'm going to try at dinner tonight to try stop that rise (all Regular). Although sometimes I enter what I plan to do, I sometimes change my mind. What I list for the future is a rough idea to help me remember that I need to change something.  This is a living, breathing file that is constantly in motion.  If you look at the very bottom, each week has it's own sheet. 

There are two supplemental sheets.

The Weekly Averages sheet is just transferring over the BG and SD averages from the "main log" at the end of the week to a sheet of it's own, along with significant notes from the week.  I use this to guestimate his A1C between Endo appts.  For the past 3 years, I've estimated his A1c within 0.1 accuracy

The last supplemental sheet is just his A1c's along with any high-level notes.  The entries automatically update the graph.

 
NOTE: this post isn't really about doses or how to maintain control, but I do want to point out something you see in the bolus fields of the "main log" (ND 1:4 and RD 1:4). We dilute insulin, so ND 1:4 is code to us that means Novolog Diluted to a 1 to 4 ratio (same for the R). We write down what we pull from the syringe because it's easier, but that means using the top breakfast example, Novolog is actually only 0.6u and Regular is 0.5u = so 1.1u for the whole meal.

Seasoning

Really good all purpose seasoning with no added sugar! 

Bacon Steaks

A bonus of living in a farm and raising your own pigs? Bacon as big as your hand. I call these bacon steaks. 

I encourage everyone to find a local farm for your meat source. Visit the farm, look around and ask questions... what ingredients are in the meat, do the animals look clean and happy?

Bacon, eggs, hot "cereal", plain yogurt with Walden Farms strawberry syrup, iced vanilla latte.  6 net carbs.

I'm Lovin' It!

I'm Lovin' It! I wonder if I can get McDonald's to pay me for this post?

Today is only the second time my kids have been to McDonald's. (🤔 ok, so maybe they won't pay me.)
I spent a lot of time on McDonald's nutrition website, which is actually quite good, and came up with a food game plan. Fortunately his CGM has been spot-on all day, so that helps!

4:45 - 6:15 on this graph includes really low carb snacks that I spread out during a movie that I didn't have to bolus for. (Yes, I snuck my own snacks and a bottle of Bai into the theater.)

At 6:40 we did his FP (81) and bolus in the car in McDonald's parking lot. By the time we ordered, got our food, and got it ready to eat we started eating at 28 minutes after his shot. At home we eat 30 minutes after his shot so timing worked out really well.

They had a bunless double-cheeseburger (no ketchup, or onions), and half a Bacon Ranch Grilled Chicken Salad. You'll notice in this picture that I brought in Quest protein chips and our own ranch dressing because I discovered last time all of their dressings are really high in carbs. (I just bought them the happy meal toy.)

Great movie/dinner experience!

 

Standard Deviation – What is it and Why is it Important to a Diabetic?

Standard deviation (SD) is a bit complex, but in simple terms, it's a statistic that tells you how tightly all the various examples are clustered around the mean in a set of data. When the examples are pretty tightly bunched together, the standard deviation is small. When the examples are spread apart, that shows you have a relatively large standard deviation.

For a diabetic, knowing your SD tells you how well controlled your blood sugar is.  For example if you have an A1c of 5.0% - many would look at that number and think “that’s awesome!”.  But is it?
How you obtain your A1c is just as important, perhaps more important, than the number itself.  If achieving an A1c of 5.0% means that you have very large blood sugar swings, say from 40’s to 300 (large SD), a lot of damage is being done to your body due to the rapid swings. An A1c of 5.0% is really not very good in this scenario.  However, if you achieve your 5.0% with blood sugar levels ranging from 60’s to 120 (small SD) there is no damage due to the tight control and you have a healthy blood sugar average.

So what is a good SD?

A very good SD is 25-20. A great SD is under 20.  Where did these numbers come from?  A non-diabetic with a healthy A1c will have a natural standard deviation of about 5-15 mg/dL.  That's how tightly our pancreases control our blood sugar.  I tested this personally... my Non-D daughter wore a CGM for 2 weeks and her blood sugar average was 79 mg/dL with an SD of 6.  I wore a CGM for 2 weeks and my average blood sugar was 91 mg/dL with an SD of 11.  Trying to achieve that tight of an SD with T1 diabetes just really isn't feasible... at least not consistently.  The <20 - 25 SD is a bit arbitrary, but it is realistic for someone that wants really great control. The lower the SD the better because the tighter the control you have.  Remember the whole point of knowing your SD when it comes to diabetes is to avoid blood sugar swings.  Minimal swings means less damage to your body!

How do you know what your SD is?

If don’t have a CGM, you’ll have to calculate it manually.  There’s an app for that!  Just search "standard deviation" in your app store and you'll find free ones.  It’s really simple… plug in all of the #’s from your finger pricks (FP) for a day and it will give you your SD.  Do that each day and then you can average your SD for the week or month. You can also use an Excel formula.

Here are some examples in the Google Play store:

If the app you use lists both Population SD and Sample SD, for blood sugar purposes, use the Population SD.  It looks at all the BG values you entered. The Sample SD is only looking at some (a sample) of the values you entered.  An SD calculator looks something like this:

After you calculate, you'll get your SD results:

The downside to FP's is that your set of data is very limited.  There are 1440 minutes in a day.  If you FP 12x a day, there are 1428 minutes left that you don’t know what your blood sugar is doing.  But on the plus side, the data you do have is very accurate!

Another way to get your SD is if you have a CGM.  A CGM sensor is reading your interstitial fluid (ISF) every 5 minutes and is estimating what your blood sugar is.  It sends this data to your CGM receiver which can be downloaded to pull reports that calculates your SD for you.  The pro is that you have lots of data.  The con is that CGMs can be off; sometimes a lot.  They often don’t read the lowest lows or the highest highs.

I have a lot of T1 friends that love their CGM reports, but a downside is that the data can be skewed because it’s all interstitial data.  Their report may show their A1c is 5.0% with an SD of 15, but then their lab A1c is 5.5%  The reason is because the CGM is off, and if the A1c is off, so is the SD.  The point is to be healthy, not simply achieve a number.  I don’t care if a report shows an A1c of 4.5% with an SD of 10 if that’s not REALLY what is happening in ones body.

So what do you do?

My opinion is that if you have a CGM you combine the best of both worlds – lots of data points (CGM) plus accuracy (FP's). Get your CGM SD from your report.  Then take the SD from actual FP's and average the two to get a truer SD.  If you use Dexcom, you’ll have to combine and average this manually.
Medtronic CGMs also record FP's so when you pull a Carelink report it will show you your FP SD and your CGM SD… all you have to do is average them out.

Summary: looking at A1c or SD alone can be very misleading, but together you have a powerful tool.  I hope this helps simplify SD and helps you to understand why it's so very, very important to your diabetes control and health.

There is another formula that I’ll cover in another post that adds a 3rd layer and provides even more insight to overall diabetes control… %CV (Percentage Coefficient of Variation).  Sounds funs, right?

Leftover Desserts

If you have leftover soft desserts, like cake with icing, lay individual slices on a parchment lined baking sheet, freeze just until hard. Then you can wrap in foil, place in a freezer bag and keep in the freezer. Be sure to label with carb count. When I don't feel like making dessert (or, umm, forget), I just pull out leftovers to thaw.

To-Go Bag

There are places we go that have a "No outside food or drink" rule - indoor water parks, parks/zoos (like Grant's Farm), movie theaters, etc. I will abide by this rule *IF* they have food - including snacks - that's low carb. We can usually do fine with meals, but not usually snacks.

I could go all Mama Bear on them and remind them they are in violation of the ADA (Americans with Disabilities Act) which diabetes falls under. However, I prefer to avoid conflict and fly under the radar when I can.

What I do is use the insulated soft cooler in this picture which looks very much like a purse that I can fit TONS of things that I need to manage diabetes while we're out.

On our trip to Grant's Farm yesterday I was carrying an ice pack, a bottle of Bai, Chomps meat sticks, cheese bites, nuts, Samuel's insulated insulin pouch, his glucose tester pouch, Glucagon, and extra syringes.  I had my wallet, cell phone and Tylenol for good measure.

I've used this countless times and I've never been questioned or searched to see if I'm smuggling contraband. 😅

Birthday Boy A1c Check

A1c test on his 7th birthday. Also a pulse check for us as our bi-annual Endo appt is next month.

Birthday Boy's Breakfast

Hearty breakfast for the birthday boy.

Rustic Faux Wheat bread topped with butter, cheese, a dirty egg and sugar-free ketchup. An extra egg and bacon on the side.

Heading out soon for a fun day out for the birthday boy. All this protein will keep him full and energized.

Successful Labor Day!

Lots of fun - play date with their friend, sprinkler fun (lots of mud pies!), and family time.
2 big low carb meals. 

And best of all... fantastic blood sugar all day!

Testing While Out and About

When Samuel was diagnosed with diabetes, it never occurred to us to hide the disease. No matter where we are in public he checks his sugar and give shots as needed. 

Here we are sitting in the middle of Sears checking blood sugar, and I'm so happy that he doesn't think he has to hide this.

Ruby Tuesday

Ruby Tuesday is one of our go-to restaurants for fast easy meals. We get grilled chicken breast, bunless burgers, grilled zucchini, broccoli and green beans. One thing we LOVE is the garden bar that is full of raw, LC veggies.
The kids are eating raw veggies here - not even any dressing - while they're waiting for their grilled chicken breasts and grilled zucchini.

Pub Cheese

Found this delicious pub cheese at Trader Joes. No sugar or starches added.

Chocolate Muffin Breakfast

Bacon
Eggs
Chocolate LC muffin
Full-fat yogurt with SF blueberry jam (Samuel has 0 carb Walden Farms blueberry sauce instead of jam)
Kids have 2 oz of veggie juice. I had an iced latte.

Kids = 6 net carbs
Mine = 10 net carbs