When I started my career in nutrition 22 years ago, the field of diabetes did not interest me at all. In fact, back then I never would have believed that not only am I now interested in the field, I am excited every day about what I do. I have never been sorry I took the steps to becoming a Certified Diabetes Educator. Diabetes management is exciting because the field is continuously developing new advancements in care. New technology and gadgets are providing us with a wealth of information that can be used to help our patients – but are we using it well?
The 2014 Clinical Practice Recommendations provide valuable information and guidance to those of us who are fortunate enough to work with people with diabetes (PWD). One of the areas I find especially interesting is the guidelines for blood glucose testing. While there is no clear directive about testing, the guidelines indicate the person with diabetes individual needs and goals should determine when and how often blood glucose should be tested.
I’ll admit I’m a data junkie, but that does not mean that my patients are, and I feel strongly that blood glucose testing is useful only when the PWD understands how to evaluate their blood glucose numbers and ways these numbers can be used to guide decisions in order to reach their goals.
Many clinics are encouraging PWD to write down their blood glucose results. A written record is a valuable tool that can be used to:
- Spot trends over time. Either by time of day or day of the week.
- Encourage patient engagement. What better way to engage your patient than by using these records to start a conversation about their goals and desires?
- Provide positive feedback to demonstrate that readings are not always as bad as our patients’ think they are.
- Guide self-management decisions -- which is exactly what we want our patients to be doing. When patients analyze their blood glucose readings, ask questions, and come up with solutions, that is the ultimate in diabetes self-management!
It’s tempting when working with PWD to try to solve problems rather than listen, educate and guide people to the solution that will work best for them. While tempting, I remember the advice of a mentor and colleague of mine who told me, “It is not our diabetes to control, and therefore, it’s not our job to prescribe a goal.” This can be one of the hardest things to keep in mind as an educator. As a profession, we tend to be ‘fixers’ - we want to solve problems. It can be frustrating to realize that not every patient wants to achieve an A1c of 7% or less, and we need to keep in mind that we cannot push our desires onto them.
My mentor and I recently came up with ways in which blood glucose testing can be used by PWD in different seasons of diabetes. We created the article below titled “Analyzing Your Blood Glucose Numbers.” This article provides information to help patients understand what their blood glucose numbers mean, how to interpret them, and what action they may (or may not) need to take. We broke it into sections for people newly diagnosed with diabetes and people who have had diabetes for several years. Feel free to share this with your patients as you help them address their specific needs and goals.
Analyzing Your Blood Glucose Numbers
You poked yourself, used your meter, it produced a number, now what? Diabetes is a 24/7/365 commitment. There are no vacations or breaks, and poking yourself repeatedly without fully understanding what to do with the number can be frustrating. As a diabetes educator I believe that if someone is taking the time to test their blood glucose, my job is to help build an understanding about what that number means, how to interpret it, and what action may (or may not) need to be taken.
Blood Glucose Testing
“How often have you been checking your blood glucose?” If you have diabetes, this might be one of the questions you dread the most when you see your health care provider. How can such a simple question cause so much anxiety? Simple. We’re human, and as humans we feel emotions, want to please, and feel bad when we believe we may have fallen short. Testing blood glucose gives immediate feedback on a specific point in time. Interpreting the result, and determining if action needs to be taken, is one of the most important things you can do to meet your diabetes goals. A blood glucose reading is nothing more than a piece of data. It is not a reflection on the type of person you are, or whether you are taking ‘good’ or ‘bad’ care of yourself. Blood glucose targets and goals must be individualized. Each person with diabetes is in a different place with unique needs. Just like the calendar year, diabetes has different ‘seasons’. People newly diagnosed with diabetes are in a different season of their journey than those who have been living with diabetes for several years. We’ve put together a primer on what those numbers on your monitor might be telling you.
1. People newly diagnosed with diabetes
Being newly diagnosed with diabetes can be overwhelming. Make it more manageable by breaking it into tasks, and doing one thing at a time. Testing your blood glucose can be valuable for anyone with diabetes, but may prove to be especially valuable when you are first diagnosed. Know your blood glucose targets, and review your numbers by day and time of day to look for trends. This will allow you to bring your numbers more quickly to your target, and may even result in a lower A1c reading. Think of yourself as a detective working to solve a mystery about your health and wellness goals. For example, blood glucose testing can be used to answer these questions:
- Is the medication I was prescribed working?
- How does the food I choose affect my blood glucose?
- How does exercise affect my blood glucose?
If you are not sure where to start testing, ask yourself: “What am I most curious about?” or “What is most important to me?” If you want to know how food is affecting your blood glucose, a technique called paired testing (imbed link https://www.accu-chek.com/hcp/testing-in-pairs-tool.html) will provide valuable information. Your imagination is the only limit when it comes to understanding how your daily life and decisions affect your blood glucose.
2. People who have had diabetes for several years
After living with diabetes for several years it can be tempting to set aside the monitor at times, and take a “vacation” from diabetes. When life gets too busy it’s tempting to either not check at all, or not want to check out of fear you will be disappointed in your readings. However, being busy and frustrated might just bring a little clarity. If you’re feeling a little overwhelmed, it’s a good time to pare back your routine to something more manageable that meets your health goals. Consider changing the frequency of your testing, or test at different times on different days to look for trends.
To determine what might work best for you, remember:
- You are more than the sum of your numbers on the monitor.
- Fixating on one number, or one time of day, will only make you feel inadequate. Problem solve instead. What might be going on at that time of the day? What is your routine? Again, testing at different times of day can be very helpful in seeing trends. Ask yourself: Is this the best time of the day for me to be testing, or would I like to know something at a different time of the day?
- Do not test just for testing sake. What are you trying learn? How important is testing to you? How often do you want to test your blood glucose in a day or week?
3. Technology: Friend or Foe?
Technology in the field of diabetes is expanding and changing all of the time. Some people love gadgets, while others fear them and would rather do things ‘the old fashioned way.’ If you are in the first group remember that ultimately the technology is there to help. Whether you have a monitor that stores blood glucose readings, or an insulin pump, or combination insulin pump and continuous glucose monitor, keep in mind they are only useful if you are using the information that the technology is providing. Using a continuous blood glucose monitor will only help you if you download your results on a routine basis. Downloading your results will provide you with valuable insight. Look for patterns and trends in your readings. “My readings are high every Wednesday afternoon. I wonder what I am doing during that time that might be different?” OR “I notice that my blood glucose runs on average 20-30 points higher on the weekend than during the week. Can I make an adjustment in my routine?”
4. Things to ask your health care provider:
- Can I make adjustments to my diabetes care routine?
- How often or how much can I adjust my insulin dose at one time?
- Do you have a patient portal where I can upload and share my blood glucose results with you?
Finally, remember that your diabetes educator is your partner. He or she will work with you to develop an individualized plan to meet your health care goals. Our goal is to educate and empower you to manage your diabetes.