Today is the next installment in my weeklong celebration of Type 1 Diabetes Awareness Day: Follow It!

Managing diabetes is a delicate dance (or my favorite analogy -- a tightrope walk) of trying to identify everything that might cause a change, guess how much of a change it will be, and in what direction, and then to take steps to normalize that change. Or, less optimally, fixing changes after they occur.

One of the most useful tools in this dance is charting.

You can click on that image to see it bigger. The sheet on top is the worksheet/chart that Penny's daycare fills out for us every day. It reminds them of the individual steps to take, and then lets us know at the end of the day how she was, whether there were highs or lows, and what sites they used for her shots.

The other, more complex-looking chart, is her weekly tracking chart. Each day goes across the page; the hours march across in columns -- that lets us see at a glance if a particular time of day is problematic for her. For example, she was tending to drop low just at bedtime for a while, so we had a different insulin-to-carb ratio for her dinnertime shot that left a little more sugar in her system at that time of day.

Each day-row has multiple sub-rows, so we can separately track her blood sugar levels, the number of carbs she eats, when she gets her long-acting insulin, and separate doses for food or corrections. (The circled numbers are the actual doses given; the other dosage numbers are what the actual math works out to. I have a tendency to only show those numbers if there's both a food bolus and a correction.)

We fax this sheet to Penny's endocrinologist every Tuesday morning, and usually by the end of the day, they call us back to let us know if they want us to change any part of her routine.

The charts help us notice other trends, as well -- I mentioned Tuesday that she tends to have a particularly strong reaction to pasta, and I wouldn't have noticed that without the chart.

Matt noticed early on that she was prone to lows on nights that she had a bath -- and a few moments' research turned up that yes, sure enough, if you take a warm bath within an hour of your insulin injection, it can speed up your absorption of the insulin and make it just a little too efficient. So we changed our schedules to have Penny's baths before dinner instead of afterward. (There really isn't time to wait a full hour after her shot and then start her bath, as she likes to linger over both bathtime and meals.) Another solution might have been to reduce her insulin dose on bath nights -- we may switch to that option when she starts real school and needs before-dinner time to work on her homework.

(Or maybe I should just make pasta for dinner on bath nights, and pit the two trends against each other!)

You'll see that the daycare worksheet doesn't have them check her blood sugar levels before snacktime. That's because they have a nap wedged between lunchtime and snacktime, and we've found that Penny's blood sugar spikes if she goes to sleep immediately after eating. It generally settles back down on its own, so it shouldn't be a problem, except that of course the daycare is legally obligated to follow her treatment schedule to the letter, so they were having to call the endocrinologist's emergency line nearly every day to report a blood sugar level over 300 -- for a routine fluctuation. So, after talking to the doctor about it, we dropped that measurement.

Most of those observations and alterations would have been much more difficult to notice -- if not impossible -- without the charts. In fact, I wish we could get test results from her more often, to get a more complete picture of how various foods and activities affect her. Continuous glucose monitors are on the horizon. There are several currently on the market, but as a rule they're not terribly accurate, and none of them are covered by medical insurance. But as soon as they're available, you'd better believe I want Penny on one.

After all, the way to avoid the awful side-effects of diabetes is to keep the blood sugar tightly controlled, and the only way to control the blood sugar is to track it.

It's taken me four days just to explain how we manage Penny's diabetes, and you're probably completely sick of it, by now... But I'm almost done, I promise. Tomorrow, we'll Live With It!