One of the 64-million-dollar questions in the diabetes world is why more of us don’t do a better job tracking our blood sugars.
I know that’s been a key question in my 28 years of living with type 1.
Fitting with the behavioral change theme of this year’s ADA Scientific Sessions, and how doctors can motivate us to “do better,” a breakfast session explored the issue of BG logging and why it’s such a challenge for many of us.
An all-star trio of endos discussed this topic for more than an hour: Dr. Bruce Bode in Atlanta, Dr. Bill Polonsky in San Diego who leads the Behavioral Diabetes Institute, and Dr. Ralph DeFronzo from San Antonio. Hosted by Abbott Diabetes, the event eventually came back to the new Freestyle InsuLinx meter and how it could be used to help PWDs better track their BG data.
While the reality was this was a product pitch in many ways, the thought-provoking talk with these experts was really something I enjoyed — particularly since I’m someone who often slacks on BG logging and regularly hears about it from my frustrated endo!
A slide that caught my eye with colorful pie charts showed some interesting stats: 36% of insulin-using PWDs don’t log their test results, 46% still use paper logbooks, and only 18% use e-logbooks — all based on about 1,000 type 1 and type 2 PWDs surveyed in May 2011.
For insulin-dose tracking? More than half don’t do it. Nearly a third use paper logbooks, and 17% use e-logbooks.
Written records versus computer downloading… that’s not even the issue — it’s the number of people who don’t bother tracking at all!
Dr. DeFronzo
Why Don’t All PWDs Log Faithfully?
Some of the common reasons the panel trio identified against BG logging: it’s inconvenient, and time-consuming (despite the fact that you can discreetly do a BG check in less than 30 seconds).
Also, Dr. DeFronzo said that he frequently sees patients who’d rather have their doctor feel good about BG results, rather than using logs to inform themselves about what’s actually going on.
Yup, often we patients feel that BG checking or logging isn’t worth the effort either because we don’t know how to act on the data or because we find it “bad,” frustrating, and discouraging. The results are seen as statements of our worth, not just numbers and information you can act on.
Dr. Polonsky, resident expert on the psychological side of diabetes, said, “There’s an emotional valence attached, and it’s hard to get motivated to test and log when that’s how you feel.”
Dr. Polonsky
He’s studied the trend and found 81% (!) of PWDs asked about why they don’t test more responded with: “If the reading is high, I blame myself.”
This resonated with me to the core; to this day, I do that every time I see a high BG. After, of course, I swear at my meter and shake my head.
I’ve always been this way, but in my younger years I tried to hide my results. As a teen, I just didn’t want to “disappoint” my parents or my endo by having “bad” BG numbers… so I would make them up. That was easier and made me feel better, even if I was only kidding myself and couldn’t get past the truth of my A1C, the three-month average that wasn’t impacted by whatever my paper logbooks said. At some point, I learned that the meter could disprove what I said and so other tricks came to light, like using only half as much blood to get a lower result that I could flash around as proof I wasn’t lying.
Basically, I always assumed that those “horror stories” about losing limbs and worse became a likely reality in my mind, and led to a “Why Bother?” attitude where I just didn’t care. I wanted to be “normal” and live my life, not be defined by that big bad D that would probably kill me. I lost hope, for the most part. And a consequence of that was not testing, and then trying to convince everyone that I was doing OK so they wouldn’t bother me (lame, I know now!).
I bring this up because apparently despite all the new technology, there are still kids and teens out there who will go to any length to disguise what’s really going on with their D-management. Bode told a story about one teenage girl who went as far as using her lunch money to persuade friends at school to prick their fingers for 25 cents a poke, giving her the ability to fake “perfect” BG results right in her meter’s memory. And that’s just how she described it to Bode, despite the 12% A1C that proved otherwise.
Clearly, you have to want to check BGs and log that information in whatever format works best.
Dr. Bode
Interestingly, Dr. Bode said he requires his patients have a meter that can be downloaded in the office, and if a PWD doesn’t bring that meter – or maybe the paper log book – with results, the person is sent home!
“Because if they don’t have that, I can’t help them,” Bode said. “What am I going to do? Just socialize with them?”
Seriously?! Seems a little harsh, doesn’t it?
An endo in the audience later made the comment, “You don’t go to the dentist without your teeth, so why would you come to us without your blood glucose results?”
Polonsky said he at first felt a little queasy when hearing about that ultimatum. But after reflecting on it, he understands the reasons: because BG data is at the core of what endo visits are about.
Personally, I’m not convinced just sending someone home is the best idea. My endo may not be able to make any changes or determine how I’m really doing, but we can examine whether I’m going through burnout or something else that’s standing in my way of wanting to test and log data. That’s valuable.
An informal survey of the medical pros in the audience had few people raising their hand when asked if docs are downloading data in offices, and that’s not even getting to the whole issue about charging for this service. I’ve heard some in the Diabetes Online Community say their endos offices tag a fee for downloading data, where others (like my endo) do not. There’s no consistency on this trend.
“Whatever Works” Is the Answer
The docs said removing time burdens and inconveniences can help, but so can having more interaction and time in the doctor’s office to discuss what the BG results really mean — in an interpersonal, patient-friendly kind of way. Easy-to-interpret summary data to help inspire PWDs to keep good records is one option, they said. Polonsky pointed out the psychosocial aspects are important, and his clinic gives out stickers to remind patients that their BG numbers are just that — numbers, not statements of self-worth.
To me, logging my BG data is a matter of accountability, not convenience.
I actually do best when I’m writing my BG results down by hand, right when they appear on my meter screen. That gives me a sense of accomplishment and keeps me accountable, being able to see how it compares not only to the past hours but the same times of recent days. For me, it’s just not the same to have to plug that number into a device and see it on a computer screen, regardless of how “easy” that may be. Call me old-school, but that works best for me.
Obviously, Your Diabetes May Vary and it seems that many do best with a connection cable or wireless link putting their BG data onto a device that can then be downloaded and transmitted to their doc or CDE. Again, whatever works.
Honestly, I think it comes down the individual person wanting to check BGs and track that information. If that means finding motivation outside the endo’s office, or finding a better doc-patient relationship that includes better conversation, then I’m all for it.
In the end, we may not necessarily be defined by our numbers, but they are the bread and butter that get us to whatever definition of success we’re shooting for in our D-lives.
Anybody out there have any motivation tips? What works on best on long-term logging for you all?
I only do it sporadically when I feel I need to. If my checks with my meter and my A1c is fine then I don’t see the point. However, every so often I need to pinpoint some issue so that’s when I log. I save myself time by not logging any on target blood sugars (what’s the point?) and I mainly track trends because a random high or low isn’t going to speak to anything. Trends, however mean some adjustment may be necessary or at least some attention needs to be placed somewhere. I think that when doctors ask people to write every single thing down they are neglecting the fact that people have lives outside of this diabetes job AND writing down in range numbers or sporadic highs and lows doesn’t lead to anything. Or maybe it does-something I’m not aware of. But for now, since my management is in a place I’m happy with, I’ll stick with what I’m doing. After all, I’m pretty lazy so I settle with myself to just log as needed. But when it’s needed I go ahead and give it my all. The faster some mysterious blood sugar issue is resolved, the better!
I think that when my only motivation for testing is to know if I need to add a unit or two, it’s impossible to get motivated to log. I wish the meter manufacturers would make a concerted effort to have a standardized BG charting program and that cables to attach your meter to your computer would come WITH the meter. I know that right now, the paradigm is: free meters—costly strips, but I have the meter I have because it is the cheapest to operate strip-wise and I paid for it out-of-pocket.
Seriously, how many of you out there write out a log book for your auto anymore? My impression of people who pump (I do not) is that they depend upon a CGM to keep them abreast of what’s going on, so it seems like they would be even LESS motivated to log than I am! I would like to hear from insulin pumpers on this subject as well as their motivation to log.
I may be in the minority, but it is time someone spoke for them. Not testing and not recording is what the insurance industry likes to see. This means that their limit on testing supplies is justified – BS I say.
Granted, the cost of testing supplies is unaffordable for many, but might not be if the manufacturers could see that people actually used them and needed them.
Inconvenience, and not having time just means laziness and not caring about our health. Yes, I have type 2 diabetes, am insulin dependent, and do multiple daily injections. Yet
I test and curse instead of test and log. I’m so caught up in the day-to-day of this disease that I feel I really DO need to fight it one day at a time. I’ve been fairly successful with this approach, though it’s only been a little over a year I’ve been taking meal-time insulin. A1cs of 6.0, 6.3, 6.4 and 7.8 (very bad couple of months). My goal now is to stabilize around 6.5-6.7%. Too much lower than that and I have too many lows (6.0%, not so good for me).
Tim, I feel that you have said it all, we are not allowed to test like we should so we tend to not log what few numbers we get as it’s like putting a puzzle together when we know there are pieces missing
I test often and log the results. My meter and pump make it easy; I can scroll back thru time if I don’t have time to write things down. And I download CareLink before appts. I have LADA and sometimes I can figure out the new basal/bolus rates without the 3-day fast. Blithe advice “just don’t eat” sounds too much like ancient bs control [pun intended]. My logbook has a graph for each page. Plotting the points also makes me feel like I am doing something. I actually prefer the paper/meter version to the CGM download. More fact, less fiction. But I download because it makes all my data available to Medtronic: false alarms, bogus CGM data, pump malfunctions.
Perhaps the most worrisome part isn’t whether we supply the data, but whether anyone else cares to read/interpret it, but that goes for all healthcare records. I’ve had doctors pat me on the head and tell me I’m doing wonderfully, when I know I’m not; and I’ve had cancer doctors tell me I need repeated biopsies for spots that disappear on their own {They also wrote that I had a son instead of a daughter, which was news to me]
The patients aren’t the only ones who can be inept and apathetic.
I don’t log on paper. I utilize my carelink. And I only really download if I am noticing issues. First stop in my Endo’s office is meter and pump download. This is a better collection of data if changes need to be made.
Bob brings up a really great point. Though I feel I’m not indebted to the insurance companies-they make a living off me. So if my A1c is good (and it is) and I work hard for it (as I do) then not writing down my data for them can’t be justification for them to provide less strips. They are the ones who need to flex their moral muscles and use their brains and recognize how many people aren’t providing the data and maybe go by something else. This is a real problem in the system. I know of so many who are only allowed 1 strip per day by their insurance. Someone other than me and others who aren’t turning in numbers has got to do something different. We’re busy working just like everyone else AND managing a full time chronic condition. And even if we’re doing really well we NEED to log and turn in our numbers? Even if we don’t have useful technology to make it easier? I’ll use that energy to instead, work out or make a healthy meal.
As a physician with type 1 DM for several decades (since childhood), I don’t think it is “normal” for anyone to WANT to test. There are many reasons people don’t test – it hurts, they hate doing it, it takes too much time /effort, they don’t like the results, they think they are doing fine without it, it costs too much, they live for the moment, they think they can sense when their blood sugars are off, they figure they are going to get complications no matter how hard they try, they are burned out, they are depressed, or they don’t think it helps them control their diabetes because their blood sugars are erratic despite a lot of effort (often MORE effort than people with better blood sugars) because some people are just harder to control than others).
As a physician, I do not find blood sugars alone helpful without insulin doses, times, carbs, and comments about exercise and illness unless you always take the same dose, eat the same amount, and exercise at the same time of day every day. I have my own word document that I email to patients for them to fill in and email back or I can print it out for them to fill in by hand.
I tell patients if they lose their will power one day or for a while, or just have a crazy day, they don’t have to share their blood sugars with me if they don’t want. They can just write in “forget it”. I encourage them, however, not to be afraid to show me these results if they want suggestions how to minimize the effects of “off days”. I tell them if they are human, they will lose their will power at times and have crazy days. The blood sugars are for them, not me, but if they don’t bring in good records, I can’t have intelligent discussions with them and try to work with them to reach their “personal best” (which varies for each patient).
If they don’t bring in records, I don’t send them home, but have discussions with them about what is going on, and try to make something worthwhile out of the visit. I suspect soon the insurance companies are going to want bg records to justify how many strips we physicians order for our patients who test many times a day. It is very difficult to justify a large number of strips without having some record in the chart – unless patients can send the info directly to the insurance companies.
So, yes, I think PWD’s need to be motivated to test. Just like everything in diabetes, what motivates people to test varies tremendously from individual to individual, and from day to day, which is why behavioral studies are so hard to perform and interpret.
Numbers alone are meaningless unless you live a very stable day to day life.
I try to super log for three days before appointments… Every morsel of food, with exact times, every bit of exercise, everything. But it’s overkill to do it if you aren’t going to make changes in your treatment, and numbers alone are just worthless.
I use carlink/cam which can be described as nothing less than a godsend. My sensor average can predict my a1c within 0.1
I use it to look for problem areas, then focus on fixing that time of day.
Susan hits it on the head. Unless you live a very stable day to day life, all these numbers recorded are pretty worthless. For example, I cycle three days a week and run 2 days a week. I lift weights every other day. Now, when I cycle, somedays I go harder than others. Same with running. In addition, day to day stress adds to blood glucose confusion. And I am not even talking about the hormone differences from day to day that effects our blood sugar. And do not get me started about the 2 days a week that I do not exercise.
Then there are other problems. For example, does every 70 grams of blueberries have the same exact carbohydrates? No. If we eat fruit, depending on the ripeness, carbs will be higher or lower. Do you know how off packaged carbohydrates are on food labels?
Now, if us diabetics cannot even get good measures of carbohydrates in the foods we eat, how are we ever going to be good at predicting the insulin needs of our bodies throughout the day?
With so many variables, keeping our blood sugar on course to be between say 75-135 is a huge task.
So, you do to the endo and you show him that on Tuesday you hit 250. What can he tell you? Did you eat too much? Did you not take enough insulin?
On the one hand, when we make a high, it is not rocket science to figure out the general reasons why.
For the most part, endos have been a waste of time for me. I can figure out my problems on my own. They really do not have the answers–do they really know if a hormone reaction caused your high, or a slow stomach empyting–or a low was caused because when you ran you were dehyrated and you did sprints? Give me a break? How could they really know?
I maintain a A1C of between 4.5 and 5.5. How do I do it? Hard work–testing about 20 times a day, and watching the patterns as they emerge and responding to them the best I can–in real time– with insulin that moves in slow motion.
The point is that we diabetics have a tough job. The endo can only help us to guess where the problem is. However, we have only one weapon–insulin. And, we can do this guessing ourselves. In the end, it is a guess. The wisdom will come when we test out our guesses and see if some positive comes from them by way of our glucose meter.
Then I might add, we have another huge problem. As I stated before, we have natural bodily needs for insulin that change daily. I make the same smoothie each day (1/2 cup buttermilk, 1/2 cup greek yogurt, 1/2 cup cottage cheese, 30 grams of walnuts, 1/2 cup of blueberries frozen, and 1/2 cup of blackberries frozen). Each day, my body needs plus or minus 4 units from a target of 6 units I like to take for this breakfast smoothie. By the way, did you know that cultured products like buttermilk and greek yogurt have net carbs way below what the package tells you. The little critters in these foods turns much of the lactose into latic acid. Look it up!!! Then test it on yoursefl. I know you will be surprised how little insulin you need to take care of cultured dairy products.
What endo can really tell me what to do to manage that fluctuation need that my body has for insulin from one day to the next.
Anyway, Dr. Bernstein is right on one point: when you add carbohydrates into the diet, diabetes becomes much more complicated to manage. One reason is because carbohydrates digestion can take from 10 minutes up to 5 hours after you eat it. Insulin is not smart when injected and starts and stops also at variable rates.
Test this out: when you exercise, watch how active the insulin you have taken becomes during the exercise and after. Then a day you do not move very much, the insulin is not as active. So, you might eat the same thing on your active day as on your inactive day, but your body will need different amounts of insulin. Go factor that in.
What is your endo going to tell you about that?
As someone who has lived with diabetes for 30 years and keeps an A1C 4.5-5.5, the only advice I can give is try to limit your carbs at each meal, test often, and be careful when you are active during exercise and after. In addition, if you can and can afford it, test your blood sugar often before you drive and every 45 minutes of driving while on a trip.
Intuitively, as you test your blood, even if you do not record anything like me, you will realize patterns. Figure out your bodies own patterns. You are the expert. No endo can figure it out like you can.
As the saying goes: think like a pancreas (even though that pancreas is much more intelligent than I am).
Everyday I meditate hoping mine will start back up, because I admit it is much smarter than I could ever be in managing glucose levels in my blood.
For now, we use our dumb methods of insulin, test strips, and educated guessing. Tracking glusose levels, charting them, is no magic solution to the problems you and I face on a daily basis.
Dr. Bode, and his arrogance, will be no help. If Dr. Bode was really worthwhile, he would say to his patient: “You have a difficult job managing this disease. I need to see some numbers and some numbers on days that really confuse you. I will do my best to help you figure them out.”
Sending someone out of your office, as if you are so wise and wonderful, rewards you with the clown prize. He is the top clown of endos.
The main reason I like CareLink: I don’t have to remove my pump. My CDE has my password and can download the data whenever she needs it. I can even email her that I’m have questions;about how I want to modify things. Time and location are no barriers. She’s really great about emailing me back with reassurance and advice.
My husband and I have just recently started logging his blood sugar levels and the insulin he takes, not the amount of carbs he ate, unless the next blood sugar test was wacky. He’ll actually log them on paper and then I’ll put them in an app that I have on my phone. That app will tell me averages and the likely A1c. It’s actually rewarding seeing when his blood sugar levels are in the normal range. It tells us that we’re doing something right, and that is very satisfying sometimes.
Having lived with diabetes for 25years before BG monitors were even on the market -i.e. the only thing to monitor were urine sugar tests – which my family knew for years were unreliable – I accepted keeping a record was solely for purposes of adjusting my diabetes treatment – not ever associated with positive or negative reinforcement – it was just part of my life. As an adult I took on the profession of nursing [paediatric primarily]- when I got home from work the last thing I wanted was to chart something else! When the first monitor that could be downloaded onto a computer appeard on the market – I purchased my first computer! I haven’t kept a BG record book since – over a decade. I have always tried to use a monitor that will allow entries to extrapolate what’s behind some readings. As one commentor stated – it would be nice if the monitors would keep up electronically i.e. the choices re exercise / food / other medical concerns remains limited. At my age / longevity / the documenting of my BP is now very usefu.l I’ve asked time and again if there is a monitor that plugs into a home BP monitor as well as recording glucose – of course not in spite of the rising Type2 D population [usually includes cardiac issues]. One of the continuing problems I’ve had though is the inability of the physician to correctly interpret the printed results – and this is several endocrinologists [university asssociated] over time. I have no trouble with spreadsheets – so I will continue.
I have a cable for my meters (all OneTouch) and load them up on my computer and print out a report of my bgs for my doctor. I was never good at writing things down.
As a long-time Type 2 diabetic, the issue of judgement when taking blood sugars was prime for a long time. Although that has changed over the years, I wrote something a while ago that expressed my experiences with the issue. I wrote it in 2006 – and since I don’t know how to attach a piece to my comment, I’ll include it here:
The Glucometer
I stumble to the dining room table, smile softly at my husband as he continues putting his lunch together. Not time to talk yet. I’m too sleepy, still lost in memories of the warm bed I have just left. And I don’t yet know how I am, who I am, today. You see, I haven’t received the official word yet, that number on my glucometer that will tell me if I have succeeded or failed the past day in being the perfect diabetic. It is a futile task and the numbers keep reminding me of this fact.
I pick up my test kit, tear open the antiseptic gauze and wipe my fingertip clean of any germs. Then, after taking a test strip and placing it into the meter, I grasp the stylus and place it firmly on my finger. A click and then a moment until I am able to obtain enough blood to test. If the blood is slow in coming, I begin my self-recriminations immediately. You’re not drinking enough, Carol. My God, there is no liquid in your body! It is only the beginning of a round of judgments.
A wait of a few minutes, usually punctuated by my husbands question So what’s the number? and my response It hasn’t registered yet. Then beep and the number, my evaluation for the day, is facing me. And with it, my guilt. Too low? I should have had a snack before I went to bed last night. It’s not healthy to go so low! Too high? What did I do wrong this time? That last snack? Not enough exercise? Let’s face it – I really didn’t watch my diet that well all day. And this number proves it.
My doctor tells me to use these numbers as information only. Not as a “fail” or a “pass”. The books I read suggest that judgment is as inappropriate as feeling your car is failing you because its gas gauge is low. Information…What do I need to do if my blood sugar is high? What can I do to raise it when it is too low? Information, guidance.
My head knows this is an appropriate, even a healthy, approach. But my heart does not concur. It falls with each unsatisfactory number. Once again, I have failed. Once again, I am brutally reminded that I am a diabetic. No denial on my part changes that fact. I am not like other people. When I try to be, to forget about watching each thing I eat, each thing I order in a restaurant as I sit across from a non-diabetic friend, my numbers will remind me. Sometimes it seems as if I have been fighting a twenty-year war with my glucometer. At other times, I am grateful that I am able to have so much control over my own health. A regular workout, intelligent and balanced food choices…and the numbers applaud me. But there is no place to hide for the wicked. One slip and the numbers will remind me of who I am. At times like that, I hate the role a feel I play, a victim to a glucometer and the judgment it presents to me. And no, then it does not feel like information. It feels as if I am staring at failure. And all the theorizing about a healthy attitude towards diabetes just doesn’t do the trick. It is on those days that I wish I could have just one day when I was not a diabetic. A day without judgment. But, as I stumble toward the table early in the morning, my glucometer waits.
Carol Kodish-Butt
2006
Having been diabetic (Type 2) for almost thirty years, I certainly have dealt with the judgement issue and testing. My views have changed with the years but I wrote this piece in 2006 and I think it really speaks to this topic.
The Glucometer
I stumble to the dining room table, smile softly at my husband as he continues putting his lunch together. Not time to talk yet. I’m too sleepy, still lost in memories of the warm bed I have just left. And I don’t yet know how I am, who I am, today. You see, I haven’t received the official word yet, that number on my glucometer that will tell me if I have succeeded or failed the past day in being the perfect diabetic. It is a futile task and the numbers keep reminding me of this fact.
I pick up my test kit, tear open the antiseptic gauze and wipe my fingertip clean of any germs. Then, after taking a test strip and placing it into the meter, I grasp the stylus and place it firmly on my finger. A click and then a moment until I am able to obtain enough blood to test. If the blood is slow in coming, I begin my self-recriminations immediately. You’re not drinking enough, Carol. My God, there is no liquid in your body! It is only the beginning of a round of judgments.
A wait of a few minutes, usually punctuated by my husbands question So what’s the number? and my response It hasn’t registered yet. Then beep and the number, my evaluation for the day, is facing me. And with it, my guilt. Too low? I should have had a snack before I went to bed last night. It’s not healthy to go so low! Too high? What did I do wrong this time? That last snack? Not enough exercise? Let’s face it – I really didn’t watch my diet that well all day. And this number proves it.
My doctor tells me to use these numbers as information only. Not as a “fail” or a “pass”. The books I read suggest that judgment is as inappropriate as feeling your car is failing you because its gas gauge is low. Information…What do I need to do if my blood sugar is high? What can I do to raise it when it is too low? Information, guidance.
My head knows this is an appropriate, even a healthy, approach. But my heart does not concur. It falls with each unsatisfactory number. Once again, I have failed. Once again, I am brutally reminded that I am a diabetic. No denial on my part changes that fact. I am not like other people. When I try to be, to forget about watching each thing I eat, each thing I order in a restaurant as I sit across from a non-diabetic friend, my numbers will remind me. Sometimes it seems as if I have been fighting a twenty-year war with my glucometer. At other times, I am grateful that I am able to have so much control over my own health. A regular workout, intelligent and balanced food choices…and the numbers applaud me. But there is no place to hide for the wicked. One slip and the numbers will remind me of who I am. At times like that, I hate the role a feel I play, a victim to a glucometer and the judgment it presents to me. And no, then it does not feel like information. It feels as if I am staring at failure. And all the theorizing about a healthy attitude towards diabetes just doesn’t do the trick. It is on those days that I wish I could have just one day when I was not a diabetic. A day without judgment. But, as I stumble toward the table early in the morning, my glucometer waits.
Carol Kodish-Butt
2006
I may be one of the odd ducks out there… actually do much better when I’m writing my BGs down. Although, I really slack on doing that consistently. My endo has started using the MM Carelink system and so I’m actually able to download results into that, and email her (via my CDE) that I’ve done so and they can log in to see and print. That’s actually easy and efficient, but it steel keeps me accountable to write them down and be able to see everything with one glance, rather than scrolling back online or with the meter. Has always been that way with me, in the past 12 years of pumping and my 17 of injections beforehand. The food logs also really do me well, but I’ve rarely done that in my life except right before an endo appointment.
When I began using insulin to manage my diabetes several years ago, alot of my ideas about testing changed. Now, I use it to determine what I need to do – my own control of my diabetes. Now it really is information – and for me, not the “judges” I perceived it was for before. And, as I get to know my body with its highs and lows, I often only take my BGs when I feel different – I have a pretty good idea of what I feel like when I’m high or low and it just confirms it. I am lucky – my diabetes remains pretty stable so I don’t check it all the time. But I now have a very different relationship with my glucometer – and my doctor respects that and gives me room for it. (Because I’m in Canada, she may not have the same requirements to insurance – we do have our heath care covered by Canada).
It never occurred to me NOT to log my glucose readings and insulin doses. When I was diagnosed, the endocrinologist who taught me how to use my meter said to log the results, so I did. After a while of figuring carb-counts and insulin doses manually (I’m type 2, Lantus and multiple daily injections of Novolog), I found an app for my Palm Pilot that did the calculation and logged numbers. I later moved to the iPhone and got a similar app there.
I guess I never learned the judgmental thing. The numbers are there to be used, and the question is always “why is the result this particular number?” not “What did I do wrong?”
The answer to “Why” usually helps to bring the number more into target range next time. More/fewer carbs than usual, more/less exercise than usual, incorrect estimate of carbs or portions or whatever, I have a cold…And sometimes, because blood sugar is a bitch goddess, the answer is “I have no clue.”
Honestly, it’s like a game. You’re trying to get the numbers in the target range, and logging helps you (a) know how close you are and (b) adjust for things that might be throwing off your aim.
I imagine not testing and logging is like playing basketball blindfolded — you can hear the buzz if you sink a basket, but otherwise you don’t know how close you came. And if you don’t keep track of your results, all you’ll remember is the outliers: that string of six baskets in a row, or the time the coach yelled “quit shooting into the stands!”
All that being said, the goal here is to keep down the A1C. If people can do that without testing or logging, then obviously what they’re doing works for them.
Many of your swings in blood sugar might have nothing to do with your errors…you would never know before hand why your blood sugar raised. Can you really know how fast your stomach is going to digest something? Can you really know if certain hormones are going to be active on a particular day? Can you really know why it took your body 5 hours to process all the carbohydrates in a plate of spagetti?
The whole concept of blaming yourself is worthless.
You are not at fault.
However, listen to your blood sugar patterns, because your body is teaching you and itself.
The patterns will guide you.
However, logging one day in the hope of being accurate the next is not a full proof method.
In addition, carbohydrates are complex, even more complex than any glycemic index, and your body reacts to them differently day in and day out. In addition, we can only “guess” at the carb content of anything: even a potato’s carb load and amount will differ in the way you cook it–and get this–even whether you eat it hot, at room temperature, or cold (as in potato salad).
If you think your endo is going to figure this out for you, good luck.
You are the expert. You alone need to watch these patterns. You alone will solve your own blood sugar mysteries.
Good luck. However, your log book is not nor ever will be the holy grail solution to the problem we face.
I’ve almost always kept a simple log of tests – but it’s only part of the picture – w/out carbs & exercise it’s hard to really know what’s happening.
But if you’re on Medicare and want more than the minimum number of strips, you’re required to turn in a month of tests in a paper format. Supposedly It’s the way they know if you really need the number of strips requested.
The variety of responses is fascinating. As a recently diagnosed type 2 I’ve found logging to be very natural. This is partially from having an engineering and scientific background. My friends have said “you’ve turned yourself into a science experiment.”
I’ve seen a lot of the same range of reactions to measurement when introducing modern process management into manufacturing and business processes. The fear of numbers, the feeling guilty about “bad” numbers, etc. are all problems there too. Having been through all this before probably made it easier for me.
Also, my diabetic educator and some of the doctors have learned the same lessons as manufacturing has. They emphasized using the numbers to experiment, learn what works, learn what doesn’t, and monitor for changing conditions. They did understand the need to “eliminate fear” so that the numbers become useful rather than judgements.
Well I am 19 years old, and I NEVER EVER EVER log. I was diagnosed at 11 and of course they told me to log. I did for a little while and I hated it. Every time i try to do it even now I still hate it and it brings back bad memories. I find it way to hard to figure out how many carbs are in everything I’m eating. Especially since I’m in college now, it’s impossible to know the carbs in everything in the dining hall, let alone even try to measure portion sizes with my eyes. In addition, it’s so hard to even try and begin to estimate what could possibly be in the drinks supplied at parties.
My biggest issue with diabetes is that I want to be normal. I want to act normal, be treated normally, and do everything that everyone else does. I always get so defensive whenever anyone mentions my diabetes.
Anyway, I had my first endo appointment in a year today. My A1C was 7.5. That doesn’t seem too bad to me, but I still got the lecture about logging. I honestly hate the people in my doctors office because of how condescending they are. They don’t have diabetes. They don’t get it.
I’m considering starting to log. And also considering a continuous glucose monitor. Or maybe even a pump. But the idea of having something stuck to my body is a serious turn off. It goes against the whole “normal” thing I’ve been working so hard to accomplish. And the idea of logging being something easy and great to do is a fantasy for me, but every time i get unbelievably frustrated and think back to all those appointments when I was 12,13, 14 and crying the whole time.
I don’t know what I want to do about my diabetes. I’m definitely not a perfectionist, but I kind of wish I was.
I record my BS readings in my gnumeric spreadsheet program. I categorize the readings by time of day: pre-breakfast, post-breakfast, pre-lunch, etc. and compute a daily average for each category.
That helps me see if, for example, my bedtime readings get too high
then I might need to readjust my dinner insulin dose or curb post-dinner
snacking.
These categories help me see if I need to adjust my insulin therapy for a particular meal.
I restart my spreadsheet on the first of every month. Then I feel that
I have a fresh start to my goal of achieving normal blood sugars round-the-clock.
My spreadsheet also calculates daily, 5-day, and 7-day averages. Seeing those averages helps me know whether I need to adjust my basal insulin doses up or down. That’s the easiest way to change my daily blood sugar average.
I type my BS readings in one at a time. I don’t use any technology to do this, just my fingers. Just another of the many PITA duties this affliction requires.
I know I’m late to the pary, but the endo who says he would send me home because I’m not using a meter he can read infuriates me. WTF. Why doesn’t he have the software. My endo can’t read the results I upload to diamond. Who’s fault is that?
Fascinating range of responses, and I’ve got yet another…
I use a glucometer, a CGM, and a pump (Dex G4 and t-slim). I already manually enter numbers into my pump and CGM, I already put carb counts into my pump, my CGM has the option of adding (albeit not very detailed) notes about exercise, illness, alcohol, etc. The only thing that I don’t already record in some form or another is exactly what I just ate, I tell my pump carb counts, but I don’t tell it “pbj with glass of milk”.
I maintain that since its not my choice, or my design that leaves my 3 pieces of life-sustaining equipment unable to coordinate with each other on a report, I will satisfy some of the reporting duties by entering information as appropriate on each device, but I will not take it one step further and enter everything neatly and orderly in yet another format, because entering a less-than stellar BG reading in 3 places is pretty dreary and one of the best ways I can think of to drive myself bonkers.
Maybe once I retire (ummm, in another 30 years?) then I’ll have enough time on my hands not to feel like triple-data entry is a waste of time and pencil lead, but until then, I’ll enter data into my pump, and into my CGM, and thats it. If my Dr wants it all available in one place, then he could please contact the appropriate companies and give them, not me, that lecture.