Diabetes Self-Management Articles

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How Well Do You Know Your Diabetes Management Plan?

by Allison Blass

Many people who take insulin are encouraged by their doctors to be proactive about changing their insulin doses between visits, if necessary. If you do this, keeping a record of those changes will help keep your doctor up to date on your blood glucose control efforts. If you’d like to do this but haven’t been instructed on how, speak to your doctor. Changing your insulin doses without proper instruction can lead to dangerously low or high blood glucose levels.

For people who are on insulin pumps, having a current list of your basal rates, insulin-to-carbohydrate ratios (for bolus doses), and insulin sensitivity factor (for correction boluses) will help you reprogram a replacement insulin pump accurately in the event that your pump malfunctions and you get a new one. Your doctor will have records of these specifics on file from your last appointment, but if you have made any changes since then, there will be no written record unless you have created one.

At what times have you been told to monitor your blood glucose, and why?
Measuring your blood glucose level isn’t very useful unless you know what the numbers mean and how to respond to them.

For people with Type 1 diabetes and people with Type 2 who take insulin, monitoring is generally recommended before meals and before bedtime. Monitoring at these times helps you see trends in your blood glucose levels and enables you to make modifications in your insulin doses, if necessary. It helps you gauge how much short-acting insulin to take before meals (to cover the carbohydrate and correct high blood glucose) and to see whether a bedtime snack may be needed to keep blood glucose within the recommended range overnight. The before-breakfast check can also give you some information about your level of blood glucose control overnight. Monitoring is also recommended before driving (to help prevent the possibility of developing hypoglycemia while driving) and any time a person has symptoms of hypoglycemia.

For people with Type 2 diabetes who don’t take insulin, the recommendations are less clear. According to Dr. Edelman, “Diabetes professionals debate all the time on the importance of home glucose monitoring in people with Type 2 diabetes who don’t take insulin. For people with Type 2 diabetes who do take insulin, monitoring is important for making day-to-day adjustments, avoiding hypoglycemia, knowing when to use a correction factor, etc. For people who take oral medicines and/or Byetta, monitoring is extremely important, in my view, because it tells the person if the medicines are working and what time of day there are potential problems.”

The American Diabetes Association recommends aiming for before-meal blood glucose levels between 70 and 130 mg/dl.

If you don’t know when to monitor or why you are monitoring at certain times, talk to your doctor. Also let your doctor know if your before-meal levels are usually higher than 130 mg/dl, and ask what can be done to bring these levels down. Your doctor may be able to suggest additional times to check your blood glucose level to help with your management.

Do you know when and why to monitor after meals?
Checking your blood glucose level both before and after meals can tell you what effect your food choices and any medicines you took before the meal had on your blood glucose level. Some people routinely check after every meal, and some check after meals only occasionally or when making changes to their diabetes treatment plan.

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