DIABeducation™: First Things First

When you open up your glucose logbook, is it hard to tell which way is up? Do you even use a logbook or for that matter, a blood glucose monitor?

Self-monitoring of blood glucose is the single best way to know what is happening on a daily basis with your diabetes. Much like you want to know how much money is in your account, or gas in your tank, you need to know how much glucose is traveling through your system. Why? Glucose control prevents all kinds of diabetes complications.

If you don’t have a glucose monitor, ask your doctor to refer you to a certified diabetes educator who can help you pick out the most suitable meter for you and teach you how to use it. With a prescription, most insurance will pay for meters and supplies (although a few states still don’t cover this vital device). You can learn how to interpret the numbers from the experts.

Writing down glucose values in a logbook or organized chart can help you see something you might not have otherwise noticed. Many meters have elaborate functions and software programs that also allow you to identify trends over time. Whichever system you use, be sure you understand the patterns unfolding. Is a high number just a little dietary indiscretion? Or is it an overall jump in numbers throwing off your A1C (the gold standard 3-month glucose average)?

When the numbers seem to go all over the place and not have much rhyme or reason to their direction, consider the following:

1. Fix the fasting first (target range 70 to 120).

Fasting is the first glucose value in the morning after no food or calorie-containing fluids for at least 8 hours. Once the fasting is corrected, other values are more likely to follow suit. Possible causes for elevated readings:

a) not enough diabetes medication on board (ask your doctor about the need to add or change medicine)

b) increased liver production of glucose through the night (Metformin, or sometimes having a small snack before bedtime may help)

c) stress, pain in the night, illness

d) midnight snacks gone wild

2. Timing is everything.

When you write down your mealtimes, activities and medication time/dose, you might be surprised to see quite a variation. That will impact glucose greatly — not that you need to live your life by the clock!

a) be consistent with meals (do you skip meals, or vary your routine by hours, having a small lunch one day, huge the next?)

b) take medicine as prescribed (missing or delaying doses is a recipe for uncontrolled diabetes)

c) consider activity level and time of day (do you go for a long walk, delay lunch at a time when your medicine is working strongest, only to have a low, then overcorrect with too much carb?)

3. Learn about food choices (test 2 hours after starting a meal; target less than 180).

One pitfall is to assume if your fasting or pre-meal value is in target, everything is fine. That’s only half of the equation. The after-meal readings greatly affect the A1C value. The only way to know if your body can tolerate a particular meal is to test before the meal and 2 hours after. If the glucose goes up less than 50 points, the meal was OK. For example, if your pre-dinner reading was 200 (which is higher than target) and two hours later it was 250 (also higher than target) the meal was fine (in terms of its affect on glucose). In that example, the baseline is the issue.

People keep an eye on balances to avoid bouncing a check for insufficient funds, or running out of gas on a desolate road. You certainly don’t want to have a heart attack then find out high glucose was the cause. Learn more about what the numbers mean. It will make the diabetes difference.