Diabetic Management

Diabetes invaded Miles' body over 7 years ago now, putting us on a steep learning curve. We started with shots - simple insulin therapy. But Miles was only 2 and couldn't tell us how he was feeling - which was lousy. Simple insulin therapy wasn't doing the trick and our strategy escalated to 5 shots a day with 2 different kinds of insulin. We still were not getting the control we needed. After about 20 months we swtitched to the Disetronic H-Plus Insulin pump, which greatly improved our control, since it gives Miles 480 tiny doses daily - every three minutes day and night. We also must give "bolus doses" in addition to all those "basal doses" - the boluses cover his carbohydrate intake. With the pump, Miles can eat whatever he wants, as long as it is covered by a bolus dose.

Several years back, some caring friends gave us a Palm Visor Pro PDA and accompanying hardware and software that turn it into a combination Palm Pilot/glucometer/record book. Into it we enter every blood glucose reading, every carb eaten, every amount of insulin dosed, notes on his exercise regimen, his insulin site changes, every opening of a new bottle or cartridge of insulin - everything related to his health management. Before his quarterly visit with his pediatric endocrinologist, we print up a month worth of info for Dr. Brosnan's review. (One day's worth of data is almost a full page in11 point type).

Because we have all this info and can sort and access it in various ways, we can spot trends quickly and adjust our strategy when things go wrong. We can easily identify good days and "perfect" days (blood checks 100% within the target range). They don't happen too often - 3-5 times a year.

Here's the good news: In the last 9 days Miles has had 1 perfect day and 3 almost perfect days (missing the target range just barely only once on each of those days). The result is that he now has a 7 day in-target rating of 67.7% That's unusually good! Several days back he had a three day in-target rating of over 90% - a number we have NEVER seen before.

This morning his 7-day average is 135 (the target range is 80-200, with an idealized goal-within-a-goal of 130-150), with a standard deviation of only 71 (the lower, the better).

This is all good. He feels good, and his long-term health prospects are the more hopeful when we get good control. It is an unbelievavble amount of work and emotional investment, but it is worth it. His PDA is nearing the end of its useful life and will be replaced soon, the glucometer add-on hardware is obsolete and off the market now, there's newer Palm software available (though it couldn't be too much of an improvement over what we have), his pump is off the market and about to be replaced with a newer version which we hope to get at some point in the future (since his pump was said to have a life of 5 years and it's going on 6 now) but his health is good.