As diabetes educators, we know the value of keeping blood glucose records. Adding additional information such as food, carbohydrates and exercise also provide an excellent resource for decision-making related to trends and patterns. I have seen a lot of a-ha moments as we review records and am delighted to say that those moments often (unfortunately, not always) provide the educational moment that helps to motivate change resulting in improved blood glucose control.
It’s a little more challenging when out in the “elements.” I spent many weeks this summer camping, hiking and canoeing with folks with type 1 diabetes. The more time I spent (overnight vs. 4 days vs. 1 week), the more valuable the frequent testing and organized record keeping. I sat down with each individual every evening and we made decisions for the next day based on the data. It did not stop the frequent adjustments required hour by hour, but it provided trend and pattern information that gave the opportunity to minimize the BG chasing.
For example, one teen was on shots. A consistent morning trend upwards was seen upon awakening that was not influenced by food intake, but normal circadian rhythms. Unfortunately, at home she had been blamed for not bolusing correctly, and an insulin pump was not recommended by her team to correct the issue. After three days of watching the same daily pattern, it was obvious that she needed to have a different basal rate in the early morning hours. We introduced the idea of three units of rapid acting insulin on awakening, and bingo – problem solved. Obviously, a pump would be a great choice with the ability to adjust that morning basal rate.
Another example was an adult who had a history of marathon running. Canoeing was a new challenge and over the week, insulin requirements dropped by 80 percent! By monitoring frequently, recording data in an organized pattern, trends and patterns were noted early on in the week which provided the information for a major adjustment in basal rates and preventing frequent acute treatments for hypoglycemia. His CGM was also a great help; predicting the direction his BG was headed!
Handwritten records is “old fashioned” and I believe an unnecessary part of the tedium of BG control in our world of downloadable data. However, in the world of camps and camping, it is ever so helpful. The key is not how it is recorded, as that it is recorded in a manner that trends and patterns can be picked up and adjustments made based on the data.
Although diabetes is a disease requiring constant vigilance for safety and excellent control, having a system of organized data management to be able to note trends and patterns and then teaching patients how to evaluate the information can make a huge difference in the lives of those with diabetes. I’m sure you also have your favorite way to look at data. Hopefully you are coaching your patients to look at trends and patterns to help determine adjustments in a meaningful way, whether using fancy technology and downloadable data, or just pen and paper!