Winning with data
/I love data. I always have, but even more so now. I spend my days at work entrenched in data-backed analysis. Sometimes it’s sifting through our 100 million+ lines in our database. Other times it’s tracking and measuring trends to look for efficiencies in customer support. I work to retain customers using data.
When Nicky was on the way and we needed to find a daycare, I used data to choose the right one via a spreadsheet with 18 categories, weighted and graded.
My life went from scribblings of information, formulas, and algorithms piled on my desk to a complicated structure of Google sheets tracking everything I do - savings, spending, miles on my car, future plans, trips taken, miles flown, loyalty statuses achieved, and so on.
When I got diagnosed with Type1 in January I was given a simple formula - eat 35 grams of carbs per meal and dose on a sliding scale based on the finger prick measurement. Do it again as a correction before bed. I had 4 measurements and standard, programmatic reactions. That’s all I had to manage a chronic disease actively trying to kill me every day. And my A1C was 14.2 at the beginning of this. This was like building a road that takes me through the rest of my life and manually laying 4 bricks per day. That’s not the way to progress.
Around March, I got my Dexcom G6. I now had data points every 5 minutes around the clock. The only thing worse than no data is data you can’t use in a meaningful way. Every 5 minutes I knew where my sugar sat, but I couldn’t do much with it. I had pen injections with meals for for corrections, but the baseline insulin delivery (basal) was also coming from a long acting injection every night. In the morning it was still going strong. By afternoon/evening it had started to peter out. The arc of efficacy was guesswork at best and made things really hard.
In April, maybe, I got my pump. The Tandem t:slim x2 was my choice despite the pain in the ass tubing that loves to get snagged on doorknobs and toddler feet. It was the algorithm. This doesn’t just give me a basal rate of insulin and let me dose (bolus) for meals and corrections simply. It receives information from the continuous glucose monitor (CGM) and applies its own algorithm to determine if I’m falling. I can eat 50 grams of carbs and bolus accordingly. If I under bolus, I can give more without sticking myself again. If I over bolus and start a rapid decline, the pump sees the fall and cuts off basal insulin. Now some of my bolus is used as basal and the rest fights the carbs and I have no surplus. Instead of crashing to the ground, I glide smoothly to a good place.
With the ability to constantly measure and correct and adjust on the fly in micro movements, I have unlocked the ability to eat whatever I want. I still don’t eat pure sugar, but I’m liberal with carbs - as my dad bod would suggest with a glance.
For reference, here is a range of A1Cs
<6.4 non-diabetic
6.4 - 7 - pre-diabetic (for the Type 2 crowd that grows into diabetes)
7+ - get your shit together
14.2 - you’re on death’s door and I can’t believe you were on an airplane an hour ago
I was on a mission. I learned how to count carbs, bolus appropriately, do an extended bolus (a little up front and a bunch on the back side - like the mullet of bolusing), pre-bolus, set temporary basal rates, ignore my endocrinologist’s scare tactics about insulin stacking, and generally be #BoldWithInsulin. Hat Tip to Scott Benner from The Juicebox Podcast for that last one.
Yesterday I got my results for my most current A1C.
5.4!
It’s not easy. It’s tons of work. I think about my Type1 almost every minute of the day. I dream about it. It interrupts my thoughts and conversations. Friends, family, and co-workers are at its mercy every time we mention food. There are days I want to rip my site off and say “fuck it” about the whole thing.
My son, who is 3 as of this post, tells me he wants me to be better. He asks if I have my “shot stuff” and “is you medicine machine charged?” and rubs my arm while saying “I don’t want this to hurt you daddy.” On his birthday I had a slice of cake and he squealed excitedly “this is a special treat for daddy” because let’s be real, there’s no way I’m not having cake with my little boy on his birthday. Thinking about him worrying about me upsets me. He’s the baby. I’m supposed to worry about him. He’s supposed to worry about playing and whether Simba ends up being king. He’s not supposed to worry about me. And I’m typing this through tears because this disease has given my son his first true fear and he’s not even the one with it.
But I have the tools, the data, and a gnarly competitive streak. There’s no cure. I can’t win the war. But you better be damned sure you know I’ll win every battle in the war.
It takes a lot out of me. When you really boil it down you realize it’s not hard as much as it’s constant and exhausting. Giving up will kill me, quite literally. So I have no choice but to persevere. Diabetic burnout is real and is always nipping at my heels. It takes all I have to constantly outrun it, but I will not let it catch me.
5.4!
Keep reminding myself that. I’ve had bagels, pizza, sandwiches, occasional ice cream… and 5.4! Sorry diabetes, not today… not ever!