April 26, 2014

The Next Meeting with the New Member

James was happy to see us on Thursday and had lots of questions. His concern was the reduced amount of carbohydrates. Allen explained that he would use his meter to determine if the amount was too low or too high. Allen asked James when he had started his evening meal. James said about an hour earlier and Allen asked Jill if that was about right. Jill gave the time and Allen suggested that he test then. Allen recorded the time and meter reading. Allen said he would test 15 minutes later.

James was a little anxious, but I told him that by testing, he would have a better idea. Allen confirmed that and asked Jill if she had recorded the carbs James has consumed. Jill said that she had not, but could figure it out. I told her that would be good and would help us in matching the testing. I continued that we would show both of them how to maintain a food log which would help James in determining the insulin that he would need.

I started on the food log for them and Allen kept track of the time and had James test in 15 minutes. Again, he recorded the time and reading and said he would test again in 15 minutes since the last reading was higher than the one-hour postprandial reading. Allen explained what we were looking for and why. He told James that the recording and time was important because we were looking for the downturn in his blood glucose levels.

Jill and I continued working on the food log and in about 30 minutes had it complete for the day. James added a couple of items from lunch that Jill did not know about. At that time, Allen asked James to test again. Allen recorded the time and meter reading and said it is the same as the last reading, so we would do one more test and that could possibly be the last for the evening meal.

I asked Jill if she had an idea of the food for the next day. She wrote out the breakfast menu and what she would prepare for lunch. We calculated the carbs and James stated that was too low. Allen said we are only suggesting, but if you want to manage diabetes, you would be wise to consider our suggestions. Allen said you can lie to us, your wife, and even Dr. Tom, but the A1c will still give Dr. Tom an idea if you are telling the truth. Even trying to lie to yourself will not help in managing your diabetes.

Allen said it is time to test again. He recorded the time and reading and pointed out the changes to James. This reading was down sharply from the previous reading. Allen said this suggests that the high reading probably occurred between one-hour and 15 minutes and one-hour and 30 minutes. It is unusual for the two readings to be the same and that is the reason for testing at one-hour and 45 minutes. If the reading at one-hour 30 minutes had been lower, the last test would not have been needed.

Now, Allen asked what his before meal reading was. James said he did not remember. Allen asked if he would download his meter and print out today's readings. James hesitated and Allen said it is necessary when you won't record your readings on a pad of paper. While they were doing this, I talked with Jill and checked how many carbs he had for the day. He had just in excess of 130 carbs and this was more than the suggested range. Jill had her laptop and I asked her to read the email I had sent. She said she had and the links were interesting. I asked if she had a recipe that they liked and did not have the nutritional data from an old cookbook.

She reached for the cookbook and opened it. I had her join this site and then go to this page. She entered the ingredients and had the nutrition information. Jill said that was easy and I commented that it was not an accurate list of nutrients, but close enough to help in carb counting and with the blood glucose readings, they would know how close they were. I took time to go into some of the variables and said I would send her an email of where to read about more.

I told Jill that if they kept up the food log and carb count for the next few months, they would start to see patterns and this would help encourage her husband better to manage his blood glucose.

Allen and James came in then and Allen said James needs to work on recording his blood glucose readings and keeping them for the day instead of downloading his meter so often. Allen said his readings from before eating to about the highest post prandial was over 70 mg/dl. I asked James if he understood what this told him. He said Allen had said that this was too high based on the number of carbs his wife had calculated for his food. I said this should indicate that you did not inject the correct dose of insulin and needed to increase it by the formula Dr. Tom had given him. I then told James that being new to insulin and needing to lose 15 pounds, reducing the number of carbohydrates was important to prevent weight gain. If he followed our suggestions he would not gain weight and would lose weight slowly. In a couple of weeks he would be adjusted to lower carbs and would not even notice the reduced number.

Jill said that tonight was valuable for her and she was beginning to understand more of what was involved and hopefully between the two of them they could together work at improving his diabetes management. Allen said James is still being lazy in the tasks he needs to record and wanting technology to do all his work. Jill said she would work at encouraging him and I told Jill she needed to learn at the same time, but the responsibility still was his, as it was his diabetes, and not her diabetes.

With that, Allen and I said goodbye and stated we were available if they had questions. When we were outside, Allen said he would talk to Tim.

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