Many of you probably record your blood glucose in a diary or logbook, which you bring to your healthcare team on routine visits. This logbook has been an important component of diabetes treatment programs since the days of Dr. Elliot Joslin (Joslin Diabetes Center), the late pioneering diabetes specialist. Dr. Joslin believed important events in a person’s life and diabetes treatment should be entered into a diary that both that person and his health care team could refer back to for treatment decisions.
The Story of Dan
Dan is a 39-year-old man who developed type 1 diabetes at the age of 11. He has been followed yearly by his family physician since he was a child and was told of the development of background retinopathy six years ago by his eye doctor.
Dan recently read an article in a magazine about the chronic complications of diabetes and was concerned that the blurring of his vision could be from his diabetes. Both feet had been burning and tingling at night for several months and he could not remember injuring them. Additionally, he had occasional “nightmares” and had been given juice at night several times by his wife because he appeared “confused.”
HbA1cs were in the 9 and 10% Range
Dan had been faithfully taking two daily mixed injections of NPH and Regular insulin (25 N and 20 R a.m. and 20N and 15 R p.m.). Hemoglobin A1c values were between 9 and 10% (“normal” range < 6%) on most occasions and he had made every attempt to follow a healthy diet. He monitored his blood sugars every morning and states that they were usually “100 to 200.” Dan exercised daily in the past, but attributed his current sedentary lifestyle to the demands of his present employment.
Dan’s wife bought him a brand new blood glucose meter recently that stores blood sugar information, insulin doses and his carbohydrate intake. He hooked up his meter to his personal computer using a data cable and a new software package that he had heard about from his diabetes educator. Dan then entered his blood sugar goals that he had decided on in consultation with his physician and diabetes educator. With the click of a button the information contained in his meter was downloaded to the computer.
A Bigger Piece of the Pie
The information could then be converted into a choice of pie graphs. The pie chart below shows how Dan is doing overall-in this case, 12.5 percent of his readings were within his goal range, and 87.5 percent were higher. He wants to increase the slice of the pie representing his goals.
Software Helps Dan Develop New Testing Patterns
Dan brought a special summary sheet prepared by the Mellitus Manager software program with him to his next doctor appointment. This one-page summary is a condensed report of a person’s diabetes control intended for optimal presentation of information. It provides the standard-day plot, before- and after-meal, goal-view pie graphs and the preceding 14 days in a combination graph format (where diet, exercise and medication are shown with blood sugar levels) and a glucose line plot.
Dan shares this and other information with his physician and diabetes educator. They recommend he move his dinner NPH insulin from dinner to bedtime (so the NPH will peak later and last until the morning) and increase his Regular insulin or decrease his food intake at dinner. The diabetes team suggests he track his food intake by counting carbohydrates. Dan lets them know he has also decided to exercise daily in the afternoon.
Maintaining BGs with an Improved Insulin Schedule
Dan downloads his meter a few weeks later and views the graph on his computer (see “Dan’s Meter Download”). The difference these changes made over time is clearly seen. You also can see Dan is maintaining his blood sugar overnight without having to drink juice now that his insulin schedule has been improved. He then displays pie graphs of how he is doing before and after meals. Dan is so pleased with his improvements that he faxes these graphs every two to three weeks to his physician directly from the computer program. His physician is also pleased with this information and faxes back Dan’s graph with his suggestions for further improving blood sugar control.
The following has been a chapter summary from:
“Taking Control of Your Diabetes,” a new book by Steven V. Edelman, MD. You can order a copy of “Taking Control of Your Diabetes” for $17.00. This price includes applicable tax, shipping and handling. To place your order, call 1-800-998-2693
Timothy S. Bailey, MD, FACE, FACP, is a clinical assistant professor of medicine at University of California, San Diego Medical School. He is the CEO of MetaMedix Inc. and the creator of Mellitus Manager, referred to in this article.
He can be contacted at firstname.lastname@example.org.