Picture this: You’re sitting in an exam room at your doctor’s office. The nurse pokes her head in and says, “Sorry for the wait. He’ll be right with you.” Yeah, you’ve heard that before. To kill some time, you start building a miniature fort out of tongue depressors on the examination table. Add some gauze for fences and an odd instrument for a flagpole, and you have quite a little scene going.
Suddenly, the door swings open, creating a gush of air that flattens your fort. In rushes your doctor, sporting a freshly pressed white lab coat and a chart with someone else’s name on it.
“Miss Baxter, how are we today?”
Now, you sure as heck don’t know who “Baxter” is, but after waiting this long, you’re not about to let him get away.
“OK, I guess. Want to see my logbook?”
You hand him your blood glucose logbook, in which you have scribbled down several dozen readings since your last visit.
“I’ll check that in a minute,” he says. For the next five minutes, he takes you through a virtual medical whirlwind: asking the routine questions; checking your eyes, ears, heart, and feet; reviewing the status of your lab work (the nurse caught the chart error and thankfully brought him the correct one); and asking if you need prescriptions for any of your diabetes supplies. Then he opens up your logbook to a random page, thinks for a moment, and offers the kind of insight that can only come from years of schooling, clinical practice, and intense study in the diabetes field:
“Looks like you’ve had some ups and downs. Are you following your meal plan?”
If you’ve heard this sort of off-the-shelf observation before, you’re not alone. Today’s physicians are charged with so many responsibilities and have so little time to spend with patients that diabetes care rarely receives the attention it deserves. If a physician is lucky enough to offer a team of diabetes educators (or can practice medicine without the pressures of managed care), you might get some help with the day-to-day control of your diabetes. Otherwise, you had better prepare for some serious self-management.
Learning how to interpret your own self-monitoring records can get you closer to the control you’ve always wanted.
Let’s picture that visit to the doctor once again, except this time, you were prepared. When it came time to discuss your blood glucose control, you presented a chart indicating a trend of high blood glucose readings on the weekends and low readings the mornings after exercise. You ask your doctor if it would be OK to reduce your overnight insulin by a couple of units after exercise and reduce your carbohydrate intake by 15 grams per meal on the weekends. Your doctor agrees with these suggestions and adds that the high fat content of your restaurant meals on weekends may have a carryover effect to the next day.
Sounds a bit more productive than “follow your meal plan,” doesn’t it?
Becoming a recording artist
Any good record-keeping system begins with blood glucose readings. If you take more than one injection of insulin daily or use an insulin pump, you should be checking your blood glucose level at least four times daily: upon waking, before your midday meal, before dinner, and before your bedtime or evening snack. Even if you don’t take insulin at each of these times, the blood glucose information is needed to determine when your level might be rising or falling. For example, if your blood glucose is high at dinner, you need the lunch reading to find out if the rise took place in the morning or the afternoon.