By Jan Chait | July 10, 2007 10:50 am
It’s amazing what you can accomplish when you have a clue about what you’re doing.
When a doctor first told me to check my blood glucose, I’d known for eight years that I had Type 2 diabetes. And that was all I was told: "Check your sugar." I was not told how to select a meter, what to strive for, when to check, how to write the numbers down—nothing. (Not even that my insurance would cover meters and strips.)
A friend of mine went with me to select my first meter. While it came with a video on how to use the meter, it failed to come with instructions on what to do with the data once you got it, and there was no logbook in the starter kit.
I pretty much checked when I felt like it, which wasn’t often. My numbers stayed in the 200s and 300s, which meant nothing to me, until a friend who is a lab technician told me that “normal” was between 80 and 120 mg/dl or so. But nobody told me how to reduce those highs. I was pretty much maxed out on oral medicines, but insulin wasn’t suggested; I was merely chastised for not following my diet.
The results were written down in a spiral notebook, just like you would write a sentence: One after another, marching from left to right, then continuing on the next line when I ran out of space.
I was doing at least two things wrong: Checking any old time, regardless of when I’d eaten, exercised, or whatever, and writing the numbers down in a way that made no sense.
Then came my first visit with a certified diabetes educator (C.D.E.)—and enlightenment.
First, I was given a logbook with “Breakfast…Lunch…Dinner… Bedtime” written from left to right across the top of each page, with columns below to write the corresponding numbers. I was to check before each meal and write the numbers in the appropriate columns.
What a difference that made in being able to see what my patterns were and what I needed to work on! After a few days of jotting down my numbers properly, it was easy to see where adjustments needed to be made.
At that point, I was taking insulin. Specifically, I was taking two injections a day of Regular and NPH. I was also on a constant carbohydrate meal plan, which meant that I ate the same number of carbohydrates for each corresponding meal. That actually made it very easy to adjust my insulin doses. Did I wake up too low more than two days in a row? Then I needed to cut back on my evening insulin. Consistently high at dinnertime? Increase the insulin that covered that meal. I still go back to consistent carbs whenever I need to make adjustments.
Checking two hours after you put that first bite of a meal in your mouth is helpful, too. My endocrinologist likes for my blood glucose to be less than 100 mg/dl before meals and less than 140 mg/dl two hours after a meal. If I’m spiking much higher than 140 after a meal, I know I’ve eaten too much carbohydrate at once.
Or I’ve eaten something that my body just doesn’t like, because that trick—checking before eating and two hours after—can also be used to see how a particular food affects your blood glucose. I think that we all have foods that just don’t agree with our blood glucose levels, no matter what we do. Popcorn doesn’t affect me much, but pretzels do. I have a friend who can tolerate pretzels, but not popcorn. Go figure.
I remember talking to a professor once who said his blood glucose “averages around 130.” Then he told me what his HbA1c was, which was much too high for an average blood glucose of 130 mg/dl. As it turned out, he was checking once a week—every Saturday when he got up.
The next time I saw him, he was all excited. He’d taken my suggestion to alternate checking before breakfast and dinner one day, before lunch and at bedtime the next day, and two hours after eating on occasion. Turns out that—surprise!—his numbers were all over the place!
So what can you do if your numbers are too high? Eating less carbohydrate (i.e., think of pasta as a side dish, not the main course), doing some kind of exercise, or both generally help. Or it could be that either a move to medicines or a change in medicines is in order. Only you and your health-care provider can decide that.
But be sure to take those numbers in to the provider’s office with you. It wouldn’t hurt to write down what you’ve eaten, either. After all, the doc has to have a clue about what you’re doing.
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