​Good morning fellow NC Diabetes Care & Education Specialists, (Is our new term rolling off your tongues yet? LOL)
This month's blog I want to share my history with "monitoring" with you. I was diagnosed with "juvenile onset sugar diabetes" in 1962. At that time mother was taught to do a Saint Benedictine solution test on the stove to determine the sugar in my urine. Little did we know that information was already 6-8 hours old. Next was Clintest tablets (oh how we hate orange). Then came TesTape to run through urine stream. Then came meters in the late 70's (that is 1975>79 for you youngsters)
We thought a 4 minute check of the blood at home was so much better! Little did we realize how rapidly the glucose level was changing. The meters got faster and more accurate with smaller amounts of blood and easier lancing techniques (was a free hand jab in the beginning). But we still were missing so much data between checks. We thought the wonderful A1c that came out in the 1980's was the answer but again so much missing data.
Now we have continuous glucose sensors that are the bomb. We can learn patterns and trends and effects of different types of exercise and glycemic index of foods to us personally as we are all unique. The point of my blog is to help us all realize the glucose is constantly shifting and changing rather we have diabetes or not. Using the cgm's rather intermittent (scanned) or continuous, we need to teach the PWD's (person with diabetes) how to interpret the arrows & the trends rather than focusing on the number (single snapshot reading of one second). We also need to be careful in the discussion of accuracy or precision. For decades we have trusted meters that were only required to be within 15% of the lab gold standard. Comparing a meter that may be as much as 15% off to a sensor's mean absolute relative difference (MARD) needs to be taken cautiously. Teach the client to surf the glucose wave (Dr. Stephen Ponder) by looking at the dotted line and even if arrow is stable (straight across) look to compare one dot to the next to see if shifting up or down. Learn to micro-carb (1-4 grams when dots are dropping to prevent hypoglycemia) or micro bolus (if on a pump can dose half or quarter unit to blunt the upward trend). The more frequently a client scans or looks at the cgm the more improvement is seen in "control" > another negative connotative word. The new term is Time In Target and making sure target is set realistically. Start with a wider target and reduce range as PWD's learns the tool. I have a target of 70-160mg/dl and strive for 75% Time In Target or more with less than 2% low. Work with each individual to find what helps them the most.
For more information see Dr. Dianne Issacs articles in TDE or Dr. Stephen Ponder's book Sugar Surfing or Dr Steven Edelman's website TCOYD (Taking Control of Your Diabetes)