It may sound silly to say this, especially in this era of computing and high technology, but in our house, one of the most important tools in managing diabetes is a notebook, an ink pen, and three brightly colored magic markers. Of course, I’m talking about the logbook. That’s not to say we don’t also rely on complicated software to help track our daughter’s blood sugars. But when it comes to understanding and using the data to our advantage, there is some truth to the age old belief in hands-on training.
Initially, however, we encountered a problem: None of the logbooks we’d gotten free with a meter or at the hospital satisfied the basic principle that for spotting blood sugar patterns, the more information the better. The areas to write were too small, the categories too limited. There was no place to make special notes or document the entire day (10 to 12 BG tests per day in our case) on one easy-to-read page.
Within a few weeks of our daughter’s diagnosis with type 1, we went searching online for a better choice. That’s when we came across the WeeklyTrack Diabetes Management Kit from OSS Publishing. Designed like a teacher’s weekly grade book, this tracker means serious business. The format allows recording of up to 11 blood glucose readings, meal and snack time carb counts, foods eaten, activities such as exercise, other medication taken, and daytime and nighttime basal rates. It also provides such a large area for comments that we never run out of space.
Still, data are just data unless you find a good way to view and process them. This is where the logbook really shines. At the end of the week, usually on a Sunday afternoon, our practice has been to take the log, sit down at the kitchen table, and highlight the blood sugar recordings in the following fashion: Low is red, normal is green, and high is yellow. What we have then is a visual, colorful image of how exactly the week went in terms of blood sugar.
When we were just starting out, the result was mostly a neon salad mixture (and can be that way still today), with the week never leaning decisively one way or another. But because the log offers the week-at-a-glance, we were still able to spot trends at certain times of the day or with certain foods, and we could adjust our daughter’s boluses and/or basals accordingly. The result was a much more concerted effort in addressing regularly occurring, wide-swinging variations in her blood sugars, with better control.
The trends we spotted weren’t always absolute, of course, and we never arrived at the appropriate response without a great deal of effort. We’d sit there crunching the data for an hour or more, analyzing each situation that presented itself as something out of the ordinary: what food she’d eaten, the carb counts, the time of bolus, the pre-meal blood sugar reading, what activity, if any, she’d recently done, and on and on.
We computed and totaled and averaged and summed and divided, breaking all the figures back down again and again into their simplest common denominator, trying to identify a pattern. Why on one day did the eggs and banana our daughter ate for breakfast cause her blood sugar to rise more than 150 points by lunch, and why on another day did it drop?. Why last week on Tuesday did a bowl of pasta make her blood sugar drop by 100 points before bed, while this week it rose by 100?
Treating diabetes can be mind-boggling. It was exactly moments and problems like this that would cause us to scratch our heads and dig deeper for clues, sifting among the color-coded rubric of our daughter’s recent history, tormented by what it wouldn’t tell us. We’d wonder what more we could do. What values were we not tracking? What variables had we failed to plot?
For certain, the logbook wasn’t then and isn’t now the end to the challenges presented by tighter diabetes management. There is much we still have to learn about this invisible intruder. There is much we don’t understand and might never understand. Few would argue, however, that often it’s better to back away, forget for a while the things we don’t know, and focus instead on the things that we do. And there is something satisfying about slamming the cover on a notebook that you just don’t get with the click of a mouse.