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).
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.
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!
Next week: More tools that can help!