Monitoring my diabetes? Really, do I have to....

Admin
May 6, 2017
7 min read

So after you are diagnosed with the "betes" you may or may not be handed either a script for a monitor or a sample kit. Your doctor or the nurse will tell you diabetes education is a probably a good idea. Meanwhile, your head is swimming, wondering what exactly is this contraption you were just handed and what are you supposed to do with it. You get home with your meter box and all the accessories, pull out the instructions, and immediately feel like you have entered a land where English is your second language and you are completely lost when reading it.... With these feelings, you toss the meter to the side, completely overwhelmed and discouraged. You were just told you have a condition, with no cure, and you have to manage it to prevent the loss of limbs and other horrible consequences. All of this based on some symptoms which led your doctor to test for some A1 something value that supposedly tells them you have diabetes. You may or may not have been told how to manage "it" except the classic description of diet and exercise. What the heck does that mean? Starvation and no more of my favorite foods for the rest of forever? Just kill me now! Pause, and stop reading this post and please see earlier post regarding diabetes and nutrition, then come back. HA!

Thoughts flood your mind, "How can this be? I wasn't that bad with my health was I? I do not have time for this... I have xyz and 123 to do. When am I ever going to have time to deal with this? AHHHHHHH. I did not ask for this! I am not going to monitor, that is just too much." Well, let me tell you why not monitoring is a poor choice on your part.

Diabetes is a self-management disease. Say what?

This means, 95-99% of the management of this condition is on you, not your doctor. Your doctor can come along beside you and guide you, but ultimately it is you, your health, your life. Therefore, you must do your part, and monitoring falls into the category of a must do activity with the "betes".

Why do you need to monitor? To look for patterns, fix them, and improve your blood sugar overall. See, you can also have that A1 something drawn every three to six months, but you should not rely solely on the A1c value to self-manage your condition. The A1c value is an average blood sugar (glucose) value over the last three months. It will not tell you what spaghetti does to your blood sugar, if you are eating the right amount of carbohydrates, or what the stressful situation does to your health. When daily monitoring, does in fact, tell you ALL of those things, immediately. Using the correct parameters, you can self-manage your disease by fixing the outstanding values, before you are even close to another doctor visit! You have learned your body and managed your condition. Also, note the word AVERAGE in the description of the A1c value. I am no math whiz but averages can be quite skewed. WE all know an average is the addition of numbers and then dividing by the amount of numbers present. Sooooo, an average of the two following blood sugar values, 40 and 240mg/dL, would be 140mg/dL. Which the equivalent A1c value would be around 6.5, a beautiful value to receive! The recommended value in fact. The issue... 40mg/dL is WAY too low and you feel horrid, and 240mg/dL is way too high, leaving you feeling quite atrocious also. So the average of those two numbers may be quite perfect, but having one hand in boiling water and the other in ice water, does NOT leave you feeling comfortable at room temperature! You will be quite uncomfortable on both sides of the spectrum, too low or too high in regards to blood sugar. So instead, it would be better to discover the 40 and 240 immediately, fix the values through self-management and move on, not experiencing the boiling water or ice bucket feelings again.

Ok, so I get it, I need to monitor to have better control over my condition and fix the issues right away, but how often??????

Fantastic question! And one I get often. My first response is always do what your doctor told you. BUT, if they have told you once a day and not specified what they want, please, please hear me out! We have room to play with the times and learn the most about ourselves. Many clients come to me and have not been given much direction regarding when to monitor, just told once a day, and usually every morning or every evening or somewhere in between those two. So everyday they are doing it at the same time, mostly because it is easy to remember. Well, let me outline an analogy scenario for you.

Bob, he drives to work everyday, usually a 45 minute commute. He claims he follows the speed limit the entire trip, but ONLY LOOKS DOWN at his speedometer when he leaves his driveway. Same spot, every day, as he pulls onto his street from his drive, mostly because it is easy. Miles away from his home, when the cop pulls him over going 70mph in a 45mph zone, Bob responds, "no officer, I promise, when I left my house I was only going 10mph on Summer Valley street". Does it even make sense for Bob to use that speed in his argument of how he was not speeding currently, miles away from where he last looked down at his miles per hour? NO! Quite the same for you, if you only monitor your blood sugar once a day, at the same time every single day, you will not see the highs and lows through your day. You will miss when your blood sugar is at the highest, or when you have your vanilla latte to get through your mid-afternoon slump.

SO my answer to you, if you are monitoring one time each day, keep monitoring only one time, but at varying times in the day.

Here is an example week.

Monday-before breakfast

Tuesday-2 hours after breakfast

Wednesday- before lunch

Thursday- 2 hours after lunch

Friday-before dinner

Saturday- 2 hours after dinner

Sunday- bed time

If you monitor with this pattern for a month, AND WRITE THEM DOWN, you will have four values (four Mondays, four Tuesdays, and so on) of each of the seven. And I can promise you, you will see a pattern! "Oh my, I am always high after lunch. Maybe I am eating too much carbohydrate at lunch???" SELF-MANAGEMENT. And, I can also promise you, you can take these values to your doctor and they can come along beside you and help you to manage. They can help you identify whether you can continue to manage with nutrition and exercise or if medication is an option you need to explore. Obviously, I would love to say you never need medication, but this is not always the case, and when your doctor has all this information they can really pinpoint the best option for you, rather than taking a shot in the dark.

What the heck is the A1c even good for then?

It has purpose my friend. The simple answer would be as a comparison and compliance measurement. Example, you may bring in this log regimen I assigned to you and it looks amazing! Awesome, you are doing great. Oh wait, your A1c is not saying the same thing as your logbook. Could it be you dropped your meter a while back and did not realize it would impact the accurateness and even though your written values are perfect, they are not correct. Stupid meter problems....

Well, the comparison against the A1c is quite important just in case your testing technique is poor, your meter has been abused, or heaven forbid it is getting too high when you are always forgetting to test.

Ok, so what if my blood sugar looks good, do I need to continue monitoring?

Well you tell me, do you look at your speedometer even though you are not a perpetual speed demon? Ha, just kidding. You do not have to be as strict on yourself, but never ever would I tell a diabetic they do NOT have to monitor. I recommend always keeping a check on your blood sugar at least a few times, but your doctor may recommend something different of course. I am not your doctor.

Speaking of doctors, you may be thinking why did my doctor not tell me all of this?!

Are you mad at them after reading this? Well do NOT be! Here's the deal, quality care for patients/clients include whats called a multidisciplinary approach. It is a super big deal and helps to meet all of your needs as their client/patient. You may love your doctor and want them to do it ALL, but they have teammates, to back them up and have a win for everyone.

So, some of their key players with managing diabetes are Certified Diabetes Educators and Registered Dietitians. This can be two different disciplines/people (CDE's can be nurses, dietitians, or pharmacists) or one (a dietitian who is a CDE). These players in the medical field, with a referral from your doctor, will sit down with you and explain the concepts of diabetes.

When I taught the Self-Management courses, it would take anywhere from one to three to nine hours to explain everything and answer all the questions a diabetic may bring to the meeting. Now, of course, there is always the crash course, but usually the crash course focus is more about as much as they can get in, while also telling you your new diagnose, and writing/explaining your prescriptions. So do not be mad at your doctors, instead, discover who their teammates are for providing you your quality care. And come along beside your doctor with your self-management techniques. I can promise you, a team consisting of your doctor, a diabetes educator, a dietitian and YOU is a force to be reckoned with in regards to the management of diabetes.