In my first three blog postings on how I have achieved tight diabetes control I covered these topics:

The final major strategy is "Tons of Testing".

In theory, DAFNE means that I can match my food with my insulin quite happily and rarely need to test. In practice, DAFNE recommends fairly frequent testing: a minimum of four times per day and then additional tests when you think you might be going wrong. According to DAFNE you might find yourself testing anything from 4 to 7 times per day.

If I ate meals that contained very predictable carbohydrate quantities at predictable times and had very stable activity and stress levels and no infections, then I could probably get by with very few tests at all. I notice, for example, that when I eat slices of toast I can generally judge my sugar levels well. A serving of a large casserole containing potatoes, carrots, beans etc., will less easy to predict. The same with many take away meals. There's a fair margin for error. If I mis-judge the amount of carbohydrates by even 10-20% (meaning, for example, I guess 45g carbohydrates when it's really 55g carbohydrates), then I'm likely to go high or low.

I manage this uncertainty by taking large numbers of blood tests: 15 to 20 every day. If I eat a meal and rise to 9mmol/l, (160mg/dl) I take one or two 'top up' units of insulin. If I drop to 3.5mmol/l (60mg/dl)  I eat my usual hypo top up: fast acting sweets totalling 6-12g carbohydrates.

It's also important to keep records as I do this. A dose of quick acting insulin will still be taking an effect up to four hours later.

My ability to do this is greatly aided by Australia's National Diabetes Services Scheme, which gives me access to heavily subsidised blood testing strips (with a co-payment by me to make sure I'm not wasteful). At a bare minimum I reckon I've dropped my risk of macrovascular heart illnesses by 15-20% compared with my previous 'good enough' levels of control, and dropped the risk that I will develop all the other complications of diabetes by similar amounts. So there's little doubt that the cost of my strips is a good investment. However: if you're living with a health system that rations the number of strips you get, or if you live with a health insurer who limits expenditure (or, worse, if you have no health insurance), then I appreciate that my approach will be hard or impossible to adopt. In that case, the only suggestion I can make is that you start to control your diet to (healthy) carefully managed standard quantities of carbohydrate.

At the end of the day, Continuous Glucose Monitoring Systems will allow my to perfect my control even further. I'll blog about how I think those systems have the potential to revolutionise diabetes control - but how it is that the manufacturers/diabetes practitioners don't yet fully realise how revolutionary CGMSs can be - in a subsequent blog posting.

Image:High Quality Diabetes Control: Tons of Testing
A photo I took today looking from Melbourne's Royal Park towards the city, with the cranes of the new Royal Childrens Hospital in the foreground.

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Anthony Holmes June 8th, 2009 09:47:28 PM

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