I have a thing for spreadsheets. Really. I have had for quite a while. It probably goes back to my being a bookkeeper of one sort or another for all of my “working” life, and having come from a Matriarchy of Bookkeepers. There’s just something really soothing and satisfying – almost fulfilling – about building a spreadsheet from conception to end product and having it balance out and display all relevant data in all their splendor. There have been times when I’ve stressed over finances or an upcoming project, and sitting down to fiddle with the numbers has given me enough of a sense of control that I could calm myself. Every number plugged into a box and dutifully added, subtracted, multiplied and divided to come to a bottom line. There’s nothing better for getting a handle on the hard data and figuring out the best way to proceed.
Sooooo, the first few weeks of T-Bear’s transition to the pump was a little stressful. I’d had a really good “feel” for his ebbs and flows while he was on injections, for how his body used insulin at various times of the day, for how activity (at which levels and what types) effected his BG, and, most important for me, what his “magic number” was at bedtime…what level his BG needed to be so I didn’t have to worry about a low overnight. It was all very comfortable.
Til we started pumping. Then, suddenly, nothing made sense. I couldn’t see any patterns. I couldn’t predict what his BG would be from one test to the next, or how his body would respond to a bolus. And, I’ve been up two or three or four times each night since the switch, checking and adjusting, and reporting his detailed (and I mean DETAILED) log sheets a couple times a week to the Ped Endo, ever since. And, one of the first things I did after switching to the pump, after about a week or so of feeling completely in the dark, was revamp our Ped Endo’s standard “pumping” BG log sheet to suit my own needs. Quite forward of me, I know. But I’d been typing up his log sheets on the computer for several months anyway, mostly because my writing is not that clear in those little boxes, especially after it’s been faxed. So, having already duplicated it as a spreadsheet on my computer, making a few changes to the log sheet wasn’t that much of a leap.
But, really, pumping is such a different beast from injections, and I really needed to feel like I could eventually get a handle on it. The first adjustment I made was to set up a “time line” across the bottom of the sheet that showed each programmed segment for carb/inulin ratios and correction factors (the original log sheet just had a place to write out the ratios and factors). Just that one change helped me figure out a pretty significant problem with our programming. Our “dinner time” can fluctuate quite a bit from day to day depending on what’s going on (a particular byproduct of relaxed homeschooling). When T-Bear was on injections, I just did the calculation using his “dinner” numbers, no matter what time we ate. But, with the pump, calculations are made based on pre-programmed formulas dictated by fixed time segments. So, depending on when we ate dinner, sometimes T-Bear was getting a bolus and correction based on the “dinner time” calculations, and sometimes he was getting a bolus and correction based on the “bedtime” calculation…which is about ½ the insulin. So, Chinese at 8:00 was a complete nightmare high in the middle of the night, whereas the same meal at 7:00 was much less of a problem. Ooops. And, his bedtime carb/insulin ratio and bedtime correction factor didn’t start at the same time…they were an hour apart. So he could be getting a dinner bolus with a bedtime correction. But, I never would have figured that out if I hadn’t reworked the log sheet.
I also set up the basal rates to show on a “timeline” for each day, then removed the “notes” column on the right side of the log sheet, and inserted a couple of rows between each day so I have plenty of room to make notes (which I do a lot of). And, each note can be made under the appropriate hour, i.e. when we changed the programming, when we changed a Pod and why, where we placed the new Pod, etc. This was great when I called Insulet about all those Pods that fell off, because I could tell them exactly when each one had come off, how long each lasted, etc. (And, now, I know to include the Lot & Pod number on my sheets for when I request a credit for problem Pods). And, since I can now e-mail our log sheets to the Ped Endo (a new thing), I’m even highlighting stuff on the log sheet that I want to bring to the CDE’s attention, such as an unusual flurry of unexpected lows, highs caused by party grazing, when/how heavy exercise effected his BG, etc. Last week I started using an extended bolus on T-Bear’s carb-heavy meals, and I’m highlighting the ones I split so I can see whether or not it’s helping control the highs after a large meal.
All in all, I’m pretty sure the nice CDE's at the Endo’s office must think I’m a nut, being so anal about my reporting. But what the heck. It makes me feel better, and I’m pretty confident that this new log sheet is one tool in my toolbelt that will allow me, eventually, to get a real grip on managing T-Bear’s T1 on a pump. Give me a few more weeks, and we’ll be smokin’.
Besides, one of the CDE’s I talked to last week actually said she likes the changes I made to their log sheet, and that I prefer to e-mail rather than fax. Now, if I could just find someone to design a computer program that will download data directly from the PDM and plug it into my spreadsheet, I’d be all set…
P.S. If any D-moms want to see our new-and-improved log sheet, just leave a comment with your e-mail address, or e-mail me directly (Hueyhome@msn.com) and I’ll send it to you as an Excel file. Call me a dork, but I’m curious about what other Endo’s log sheets look like. Maybe you are, too....