Diabetes Self-Management Articles

These articles cover a wide range of subjects, from the most basic aspects of diabetes care to the nitty-gritty specifics.

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Unintended Consequences
When Good Management Efforts Go Wrong

by Wil Dubois, BS, AAS, CPT

Billie’s blurry vision
Billie uses rapid-acting insulin glulisine (Apidra) as part of her treatment plan for her Type 2 diabetes. One afternoon she starts to feel woozy, and she notices that her vision is a little blurry. She remembers reading somewhere that high blood glucose can cause blurred vision, so she grabs her insulin pen and injects a few units to fix the problem.

What do you think happens next to Billie?

A. Her blurry vision clears up promptly.

B. Her vision doesn’t change, so she makes an appointment with her eye doctor.

C. She gets even woozier, checks her blood glucose, and finds that she is hypoglycemic.

And the correct answer is…

C. And then her diabetes educator tells her to have her head examined. Never, ever take insulin without first checking your blood glucose level! Blurry vision is one of those symptoms that can be caused by either high or low blood glucose, although Billie was correct to think that high blood glucose is more commonly the cause. But feelings or symptoms, while often crucial warning signs that something is wrong, should not be the sole basis for taking insulin (or most other drugs). Use your feelings to guide you to your meter to check your blood glucose level. Had Billie done this, she would have realized her blood glucose was low and could have treated it, rather than taking insulin to lower her blood glucose even more.

There is also the matter of “just injecting a few units to fix the problem.” Even if Billie’s suspicions of high blood glucose had been confirmed by her meter, she would still need to calculate how much insulin to take, not just guess.

And even if Billie had had high blood glucose and done everything right, her vision still would not have cleared up “promptly.” It would have taken several hours to clear up. Of course, had Billie’s blood glucose level returned to a normal range with no improvement in her vision, calling the eye doctor would then be a good idea.

Improving your odds
Everyone makes mistakes in their diabetes management occasionally or has a run of bad luck, and you will too. But you can stack the odds in your favor by being informed, asking questions, and using the tools at your disposal (such as your blood glucose meter) to help you decide how to act to fix a problem.

Read. The patient information sheets that come with prescription drugs may not be the most thrilling reading you’ve ever done, but they contain useful information that can help you avert problems or even disasters. Some other boring but useful sources of information include over-the-counter drug labels, food labels, and any handouts your health-care providers give you about conditions you have. So sit down with a highlighter and slog through them, highlighting any parts that seem particularly important to you.

Ask questions. When you meet with your doctor, diabetes educator, pharmacist, and any other health-care professionals on your diabetes team, take the opportunity to ask any questions you might have about your care, your diabetes management routines, your medicines, etc.

Listen. Listening may be the part of communication that’s neglected the most. So once you’ve asked your questions, listen carefully to the answers, and take notes to help you remember what was said.

Check. If you think your symptoms are being caused by high or low blood glucose, check your blood glucose level with your meter before doing anything. The exception to this rule is when you suspect low blood glucose and don’t have your meter handy. In this case it’s safer to treat for low blood glucose (so that you don’t pass out or have an accident) and then check when you can.

Double-check. Double-check the information you receive (particularly if you hear some medical information from a friend or read it on a message board) as well as your memory of what you thought your doctor said (by checking your notes or any printed material you may have received from a health-care professional). In addition, double-check your efforts to solve your health problems by evaluating the effects of your intervention. If you’ve taken some action to raise or lower your blood glucose level, check it again to see whether your efforts resolved the problem.

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