February 3, 2015

Help in Diabetes Management Education – Part 6

Part 6 of 12

Learning to interpret your blood glucose readings and how they should guide your food intake is part of self-monitoring of blood glucose (SMBG). A few certified diabetes educators (CDEs) will actually teach this, but most will only use mandates and mantras. If you are fortunate to have one that is teaching this, learn from them. Those of you in the rural areas will most likely need to learn this on your own. Some rural doctors are working with diabetes patients that want to learn and training them to be peer-to-peer workers or peer mentors. In turn, they work with the doctor to help educate other patients.

I will state before I go further, each patient needs to discuss with their doctor what reasonable goals they should consider. Then you will need to decide what you are willing to tolerate for diabetes management. The numbers I will use are reasonable, but you should still select your own goals. This is not a topic that can be neatly wrapped in a bow. It needs to be individualized to the person and their goals and abilities. I would urge you to read the many links I will provide as it will give you ideas for goals.

The first link is this with tables and a discussion on managing blood glucose. There are suggestions that need to be considered. The second link is a blog of mine that I wrote about from a book published by Joslin. This surprised me and Joslin is not always talking about this and often discouraging to people with type 2 diabetes.

One factor where most authors fail is talking about “testing in pairs.” Dr. William Polonsky of the Behavioral Diabetes Institute is the person that coined this and promotes this as the best method for determining how food affects you body. This is important because by taking only one blood glucose reading either before or after eating will not give you any meaning and just a reading that tells you nothing except what the reading was at that time. This does not help in determining how the food you consumed affects your blood glucose.

This also tells the doctor nothing toward finding the correct amount of medication. Granted the doctor uses your A1c to determine how well you are managing your diabetes, but more doctors are using the readings from either your testing or from your meter to help them do this. I will cover counting carbohydrates in a future blog.

While I do not like the numbers used in this blog at DiabetesMine, this will give you more of an idea why testing in pairs is important.

The last blog I refer you to is this one where CDEs think about us a round pegs and they want to put us in square holes. I wrote this with tongue in cheek, but it is very applicable today because CDEs teach to the lowest level and don't want to work with people with type 2 diabetes when they can avoid it.

1 comment:

Denise said...

Testing in pairs is absolutely critical and I think it's criminal that doctors, educators, and even the major diabetic organizations do not emphasize its importance. Yes, you'll probably have to pay for the extra strips yourself (because no one will come out and say on the record that testing once a day is worse than useless, which would shame insurance companies into paying for at least TWO strips a day), but what better investment in your health can you make? Also, Tricare picks up the cost for nearly all of my strips, so anyone with active duty or retired coverage should at least ask for the prescription and see what's covered for them.