I agree. Sounds like you're on the right track. I'm in my thirties. When my parents are visiting, sometimes my mom will remind me to check my BG or ask about it. It's like nails on a blackboard. If all goes well, eventually, your son should care what his BG is and want to test. He will have to come to that conclusion on his own, though. I can't remember precisely, but when I was younger, sometimes I'd go for days, if not weeks without testing.
I would never bolus without testing the blood glucose first. My second rule is that glucose numbers are only valid for a certain period of time. If more than 20 minutes have passed the last check can not be used for bolusing anymore. I became T1 with seventeen and follow these rules since being eighteen. I just needed one year with T1 to convince me that these rules are necessary for me. BTW: the third rule is that I always have glucose tabs within close range. The fourth rule is that glucose tabs are a never out of stock item like insulin and test stripes. The fifth rule is that there is always a glucagon kit in the fridge. The list is long and still growing...every day we will learn something new...
I think you're doing a great job and this is a good approach for your son at this time in his life. My kiddo will soon be at that age, and I know there will be challenges with getting him to look after himself (regardless of how responsible he is at home). This seems to be a good compromise for situations where he may otherwise not bolus at all. While some may think there is no room for compromise with diabetes, I think with teens there has to be some room.
Good rules, Holger! And ones to develop for life no matter what age one is diagnosed! The only ones I "wiggle" a bit are the 20 minute rule in the morning. I get up and test and then drink my capp and check e-mail. When I go for breakfast it may be more like 1/2 hour but I don't test again unless it's lowish (like this morning was 62) or high and needing a correction.
Finally I don't bother with a glucagon kit because my cat can't seem to get the hang of syringes (despite the fact that she is only daily shots too - quite a needle collection here!)
thanks Suz, i agree, teens want to do their own thing, having diabetes is a big hastle for them, trying to help out as much as possible and making it all seem doable and less of an intrution is my approach. obviously learning all i can and taking advantage of teachable moments is part of my plan as well. i also try to make him feel responsible and valued as a person outside of being a diabetic! best wish to you and your son! amy
I've done it very rarely -- even knowing it's a dumb thing to do. Typically it's before a meal at a meeting where I just feel awkward to test and can't break away to do it. But the first second I can do it -- I will follow up with testing. The few times I've done it, because a meal has always been the catalyst for the bolus, I've never gone low as a result of my poor decision.
I’m another old timer who spent many years testing urine with no home BG testing. Of course we didn’t have rapid insulins either, so we blindly had BG peaks and valleys that mirrored the Swiss Alps. But one thing we didn’t have much of was guilt.
I think that parents and diabetic children today have so many tools for better BG control, but sometimes end up with unreasonable expectations and tons of guilt when things aren’t perfect. I would never tell you to lower your expectations of good BG control for your son. But I think it is possible for him to safely bolus without always testing his BG. Obviously he has to have a clue of carb counting so that he takes an appropriate bolus for what he is eating. I agree with you that he should bolus conservatively. Yes, he may get some highs but he is definitely better off than not bolusing at all. And think of all the times that he tested, bolused, and still had crap numbers because it’s impossible to be perfect at Type 1. Adolescent kids and their hormones make perfect control pretty darn impossible.
As a parent, I know you realize that you need to balance your son’s mental health with his diabetes care. This isn’t easy at all, but it sounds as though you’re doing a great job.
You soon learn that carbs and carbs are different and other factors vary absorption.
Having a glucose test result is only one factor in how insulin will react anyway.
The more of these continually moving targets you take into consideration as you become realistic with your management, the more comfortable you feel taking an educated guess.
Quite often they become more accurate than what would or should be dosed on paper anyway.
Try being a diabetic for 20 years and working your way around pizza or Chinese food. The stuff I pull on that type of meal (though honestly I try to avoid it) doesn't make any sense at all on paper. But it works, and I know it will work because I know what I need.
So I say, yes test, but there comes a time when it isn't enough and you have to fly by the seat of your pants anyway...
Excellent post! I am 27 years old and have had D since I was 7. I remember very clearly my teenage years and going through similiar encounters. I am very fortunate to have 2 loving parents who also shared the same concerns as yourself. I would put my insulin in my pocket and before we would eat I would use the restroom stall and inject. I also would make strange adjustments because I was a baseball player in high school and college as well. I think you are doing the right thing on giving him reasonable free reign over his diabetes. In a perfect world we would be able to test and bolus, however the world throws us in many directions unforseen. As long as he knows what he is about to eat and carries more than 1 syringe, I trust he will do the right thing. Diabetics know their bodies very well and can feel the highs and lows. I am sure he will adjust to it accordingly
I bolus occasionally without testing. For me, the risk of going low is pretty minimal since I tend to be pretty "hypo" aware. The important thing is to make sure your son is testing regularly and often (normally) so he has a good idea of where he is and how he's going to react. Compared to the days when I had to survive on urine tests and NPH & Regular insulin, skipping a BG test is pretty tame.
Unfortunately, there seems to be quite a few "over achievers" around here that sometimes make it feel like anything less than 100% perfection is a failure. Life doesn't work that way. For example, my daughter has always been a straight "A" student over achiever type. She recently started a part time job in addition to taking some tough classes and being on the cheer squad at her high school. When she started to self-destruct from all the pressure. I had to sit her down and explain that you get the same "A" with 93% as you do with 100%.
I'd say if you can get him through his teen years with minimal damage you've "won".
Good points, Darren!
I'm another old timer who spent many years testing urine with no home BG testing. Of course we didn't have rapid insulins either, so we blindly had BG peaks and valleys that mirrored the Swiss Alps. But one thing we didn't have much of was guilt. : I totally agree, Lathump. We did not know and we did not feel at all guilty about the unknown peaks and valleys,which I think was a mental health bonus for me, frankly...
I do not do it often , I have bolus without testing. if I have ben pretty stable and I am eating a light lunch, I will someitimes, but not often bolus for a quite familiar carb count lunch without testing, rarely do it for breakfast, snacks or dinner.....I agree it is a balance between overconcern and being safe...but you are doing quite well, Jacob's mom; very well in letting Jacob be Jacob as he grows up, both safely and happily, with diabetes.
God bless,
Brunetts
*nod*
Good perspective there.
I bolused very haphazardly throughout most of the time I've had diabetes due to poor education and being self-conscious around others. Sometimes it is not realistic to have to test every time you eat. The important thing is that he can recognize the signs of a high or low BG and that he keeps testing throughout the day (ie. it would be bad for him to only test once or twice). My doctor even told me the last time I saw her to just test after every meal and then beforehand for one meal. Now I have a CGM, which makes me feel comfortable doing this.
I think you've been approaching it in a good way. Don't nag him about his D. I can't tell you how much that has bothered me over the years (my mom still does it). Support his decisions and embrace/reward good behaviors.
I bolus without testing, although I try not to make a regular habit of it. Sometimes, I find myself eating without having my meter handy, so I will guess at the number of carbs in the food being consumed and bolus accordingly. My idea is to try to keep blood sugar levels in check until I can get to the meter to check to be sure of the current levels and adjust accordingly. It works, sometimes. Other times, it is a dismal failure.
In the long run, I think it is better to bolus, but be conservative on the amount of insulin administered, than it is to skip a bolus and go sky high. This is a tight rope, but it is one that has to be occasionally walked. I certainly am happy that I no longer have to count exchanges, whatever that was, and have a good idea what carbs are and how to use them to our advantage.
Good luck, Be well
Brian Witman
I thought I would add to this after having a conversation this weekend with a co-worker who's boyfriend is a type 1 on long acting and short acting shots.
He is uninsured and doesn't test at all. I mean literally never. While he has a small number of test strips, he can't afford to regularly purchase them and so he survives on a heightened sense of going low and how awful he feels while high.
She told me today that he had an A1C test back and it was 5.2.
His doctor told him it was one of the best she'd ever seen and he was in perfect health.
And here's me looking like the bionic man with my continuous glucose monitor and insulin pump, and I don't get anywhere near that good.
It does make you wonder. We are told to test and test and test, and I imagine if I were an endo I would want you to do the same. How else could I possibly do my job otherwise?
But if you read between the lines a little, you see a lot of people doing pretty well all by themselves. While we hear a lot of horror stories to keep us on the straight and narrow, even the older generation who survived on not particularly long acting insulin and urine testing are still among us.
It also makes me wonder how the hell he did that. His body is NOT running like mine.
i would have to say luck must have some component!! but he must eat very healthfully. and as you said be pretty in tune with his body. it does get you thinking that we can be really overkilling everything so focused on every number while your friend is busy living his live, very mindful but certainly not sweating the small stuff. mind you i am not ready to fork over his pump and meter, we really need those tools with his recent growth, interesting story though gets you thinking! thanks for sharing and best wishes! amy
Yeah, I definitely wouldn't think this is typical. Most people who were only able to manage their blood sugar like that would have dangerously high A1C's. I do believe that some of us have more "the luck of the draw" in managing our blood sugar easier than others - but a 5.2 - with little testing ? My guess is that he is in a honeymoon or there is some other factor we don't know about.
Good Answer!
few possible explainations:
Maybe he's still making some insulin.
Maybe he eats very precise amounts, and doses perfectly.
Maybe someone is not being entirely honest.