Print New to Diabetes: What’s Next? (Part 2)

There’s a lot to juggle when you have diabetes, and at times, you may feel as if you’re in a circus. Between balancing eating, physical activity, medication, and appointments (not to mention all of the other things that you need to do every day), it’s not surprising that many people tune out and throw up their hands. “It’s too hard to have diabetes,” they say.

Yes, it can be hard. But remember that you have tools available to you to let you know how you’re doing. It’s much like the dashboard in your car. Little lights come on when there’s a problem or something that needs your attention. Gauges tell you when you’re low on gas. And, of course, there are those funny noises that pop up when things go really awry.

Hopefully you won’t wait until things really DO go haywire with your diabetes for you to focus on self-care. There are two tools for you to know about and take advantage of. These are your guides for how everything is going. Without them, things will be up in the air, like those balls that you keep juggling. And you won’t know how you’re doing until something more serious happens. Don’t let it get to that point.

Blood glucose monitoring
Blood glucose monitoring (or “checking”) is your day-to-day guide that gives you a snapshot of what’s going on. If you think about it for a moment, it’s pretty amazing that a tiny drop of blood holds a wealth of information about how your food, physical activity, and diabetes medicine (if you’re taking any) are working (or maybe not working) to keep your blood glucose in a safe range. Hopefully your provider or educator has spoken with you about checking your blood glucose, and you have a meter, test strips, and logbook to get you going. Who needs to check their blood glucose? In my opinion, anyone with diabetes. But, especially those folks who:

• Take insulin
• Have started on a new and/or different dose of diabetes medicine
• Have an A1C above their target
• Are pregnant
• Are having a lot of low glucose readings
• Can’t feel low blood glucose (a condition known as “hypoglycemia unawareness”)
• Have made changes to their eating and/or physical activity plans
• Are sick or have another chronic illness that can affect their blood glucose

When and how often to check
Your provider or educator should give you guidance on when to check and how often to check. People with Type 1 diabetes, for example, often check at least six times a day, and maybe more, as they are frequently adjusting their insulin, food, and activity around their blood glucose. People on diabetes pills may only need to check once or twice a day, depending on how well controlled their diabetes is. People managing their diabetes with healthy eating and physical activity might only need to check a few times per week. It varies.

You may need to check more often when there are changes made to your treatment plan, when you’re not feeling well, or when you’re more active than usual, for example. Again, your diabetes team should give you guidance. As for when to check, a person with Type 1 diabetes will usually check before each meal and before bed, but often will also check two to three hours after a meal. People with Type 2 diabetes might check before meals and bedtime and occasionally check two hours after a meal.

Because health plans tend to only cover a certain number of test strips for people with Type 2, these folks may need to alternate when they check. For example, for one week, they might check before two meals every day. Another week, they might check before another meal and again two hours after that meal. Checking before and after physical activity is important, too, especially if you take diabetes medicine that puts you at risk for low blood glucose, such as insulin or pills like glipizide (brand name Glucotrol), glyburide (Diabeta and others), or glimepiride (Amaryl).

Log it
Most meters these days have a memory, which is helpful (make sure you set the date and time on your meter). But it also is valuable to keep a written log (or a computer or smart phone app log) of your readings. Why? Looking at a series of numbers lets you see patterns and trends. For example, you might take a look at all of your prebreakfast readings for the week and realize that you’re consistently running above your target. Or maybe you see that you tend to go low after going for a walk before dinner.

Spotting patterns gives you and your health-care team the ability to then take action. If your morning blood glucose readings are high, you might try changing or cutting out your bedtime snack. Or maybe you need a higher dose of medicine. If you’re going low because of physical activity, perhaps you cut back on your medicine or eat a small snack beforehand. If your numbers are all over the place and you can’t see patterns, then you need to rule out factors like not taking your medicine as directed, eating varying amounts of carbohydrate, skipping or delaying meals, not planning for physical activity, or having an underlying infection or illness. Don’t forget to take your blood glucose logs to your appointments.

Don’t judge
Some people find checking and logging their glucose readings to be stressful or upsetting. This can be the case if you’re seeing a lot of high and/or low readings. Try not to let this upset you. All information is valuable. Your numbers aren’t a reflection of who you are. They’re just telling you that a change or a tweak is needed, in most cases. Use the numbers to your advantage and don’t take them personally!

Comments:

Thanks Amy , your blog today gave me an extra boost and the info was vey helpful.

Posted by: Annette B | Jan 16, 2013 09:47 PM

Yes your glucose meter is your friend and the path to a better life (longer one too). I learned this years ago and set a goal of readings no higher than 140 -- a point where damage to your body occurs (most recent research). My "written system" was a real pain at first, but after I designed it to suit me it has become a necessary part of everyday life -- gives me the discipline I need to stay on track. Of course once I began to see certain health problems gradually disappear I knew I had a good thing going. Essential part of good health for me. As I say, what ever it takes -- so worth it! With my type of insulin dependent diabetes I test 7-10 times a day. You get used to it... just a little inconvenient at times, specially (like me) if you don't want to draw attention to yourself. I really liked the article of the week on high blood glucose. Hope my doctor reads it too :) Self education is VERY valuable.

Posted by: JohnC | Jan 16, 2013 08:02 PM

Jim.. I hear you about the cost of strips. At up to 300 count a month it ain't cheap. Here in BC, Canada I can get them for about $42 a hundred and part of the cost is covered. No doubt though I have saved our health care systems buckets of money with my great control -- of course I'm not doing it for them. I looked with envy at the posting a few weeks ago that Walmart was offering Test Strips $9 for 50. Still have the article sitting on my desk to check out at our local Walmart (Canada). Sure would be nice if someone who tried these would report on their accuracy, etc. Do you think health care systems are a bit of a joke? No really! Sure does tell you something, doesn't it. I get the feeling when they see a senior coming (me) everyone is rubbing their hands together. I do see, what appears to be, some sad faces when they discover I'm in such good shape :) No sir that's not my camera case on my belt.. it is my meter in disguise.

Posted by: JohnC | Jan 17, 2013 05:32 PM

Excellent comments from John C. I hope we finally see Medicare/drug industry accept the need for sufficient testing with caveman fingerprick machine and properly support cheaper strips and stop the witch doctor - 3 degree village idiot stunt of attempting to reduce strip usage at every turn by ramming costs through the roof. It is time to properly fight this epidemic with the rational tools we have and that their prices low enough to reduce meducare costs as well as facilitate personal buying of the strips at a cost effective price. Publicity and mouthing useless chants are not solving this problem.

Posted by: jim snell | Jan 17, 2013 11:27 AM

Thank you both!

Posted by: acampbell | Jan 17, 2013 01:01 PM

JohnC: Having fought and done testing on a large sample of different strips and how they perform on my body, your question on accuracy are most germaine. That said, I would like to see the scientific treatus that defends this " use as few strips as possible" not withstanding the explosion in type 2 numbers and the only way to control the mess is monitoring eating and carefully adjusting diet and exercise by checking on each meal. One a day test strip does not fit in that mess nor for the diabetic who must closely monitor insulin either by pump, injections and even using 12 hour 75/25 insulin once a day that still require close monitoring to prevent lows and be safe. So, my lowest number would be 3 a day for non insulin using type 2 with one strip - wakeup, one at meal peak (dinner) and one at midnight and minimum 5 for the insulin using diabetic with no peak meal numbers tested. There is no way I can see one a day and 3 a day for insulin using. I believe the NIH and Medicare and government need to come clean on their thinking.

Posted by: jim snell | Jan 18, 2013 08:37 PM

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