Last week I re-educated a darling couple for the 3rd time to help them gain blood glucose control. They have only relied on their A1C results up to this point since they refused to test themselves daily. I have seen many patients with diabetes over my 25-year career, but these two had every excuse NOT to make changes to improve their diabetes control and overall health. That day’s session focused specifically on blood glucose testing. Some of their excuses were legitimate while other reasons were just plain silly.
Again as an educator, I have to honor who they are and gently try to guide them back on track since these new behaviors and habits need to become a lifelong commitment. Happily, at the end of the visit I think I finally caught their attention and hope at the next visit they will have made some lifestyle changes including checking their blood sugars on a daily basis, documenting their results, and using that information to make decisions and choices with the numbers.
I would like to share the list of the most common reasons why patients, like this couple, refuse to test and give you answers as to why they should.
- I forget. I always use the example – brushing your teeth and washing your face. Rarely this is something we forget to do and testing your blood sugar should become a habit just like brushing your teeth. Leave your meter out (except in the bathroom, which has too much moisture) so you see it immediately. If tucked in a drawer you are more likely to forget to test. Carry it with you and do not leave it in the car.
- I have no time. I gently remind them that the entire procedure takes less than 5 minutes and no one has time for future complications either; going for dialysis takes 3 days a week for hours – that is really time consuming.
- Do not want to know results or see “bad numbers”. There really is no such thing as a bad number. It is a number to give you information so you can follow through with better choices next time and improve overall glucose control. I have many patients who go out and eat huge meals (making poor choices) and then refuse to test because they are afraid to see the numbers or do not know what to do with the numbers. This is a great time to test 2 hours after the meal to see where you are. If you raise your blood sugar more than 50 points, you need to rethink the meal. Could it be the food choice or portion size? This is good information, so learn to use it. Remember, you may see a higher number in the morning – even if you did not eat a lot at night – due the over-production of sugar by the liver and increased insulin resistance in the morning. Again, use this information by eating a small snack of protein and carbohydrate prior to bed.
- Do not know how or when to test. Cost of testing – if you have not received this information from your physician at the time of the appointment you should ask before leaving. A staff member is capable of helping you. You can also check at your pharmacy for meter instruction use. Every diabetes monitoring kit has an 800-phone number with a professional that can offer instruction. If you are not getting answers you are seeking, research a diabetes accredited education/management program where you will definitely get answers.
- Hurts too much. There are simple tricks to proper testing. Always wash your hands with soap and warm water instead of using alcohol which can dry out your skin. Patients with diabetes already have dry skin and can develop cracks near the nail bed, which can result in an infection. Most meters require just a drop of blood (you do not need to wipe the first drop with today’s meters). If you are having trouble getting a drop, shake your hand below your heart or massage your finger above the testing site as this will stimulate more blood flow. Use the sides of your fingers which have less nerve endings instead of the ball of your finger. Rotate your fingers instead of using the same finger, which builds calluses. Use a fresh lancet each time for your best stick. Once it pierces the skin the coating comes off and decreases the sharpness of the lancet; this makes it hurt more. You can regulate how deep the lancet sticks you with a number wheel on every lancet device. If you use your hands a lot and the skin is tough, dial up a higher number; otherwise use a lower number for a gentle stick. It is still recommended to use the fingers which give more accurate results as compared to alternate site testing.
- Embarrassed. Over 24 million people in the United States have diabetes. Most patients can usually test in a private situation but if you need to test in the open, most people are more than understanding. Embrace this moment to teach others about good practices of self care.
- “Acting out” so family members do not tell me what, when or how to eat. This is a very common issue with patients. They feel safer not being told by others, “you made yourself get high numbers by what you ate” or “you know you are not supposed to eat that”. You need to address this with family and friends early on and in a kind way remind them you are in control of yourself. Family and friends always feel like they are being helpful, but most patients disagree. You need to understand what kind of person you are and how much support and prodding you need from your support system. Always be frank.
It is a good idea to check with your healthcare provider to see how and when they want you to test. If they have no specific suggestion, you can vary the times. You can test at varying times of the day around a meal. Start with a fasting test then switch to testing before lunch, before dinner or at bedtime. The next day you can test two hours after a meal and keep changing the meal so you can see how different foods impact your results. You can test if you are starting a new medication, or changing the dosage of medication or reducing medication. You can test before or after your exercise. Another new and popular way to test is called pairing. It was created by Dr. William Polansky and lets you track cause and effect. Test every other day but test 2 times on that day. For example you can test before and two hours after breakfast, lunch, or dinner. You can test before and after sleep or before and after exercise. Vary and experiment with your testing to see patterns and trends. If you or your health care provider does not feel you are getting enough information with just one daily glucose check, you may benefit from ordering additional strips and paying for them out of pocket. Document all of your test results in a log book so you can actually see the patterns and share them with your healthcare team.
These techniques can help with improved blood sugar control. It gives you more information than just the 3 month A1C test. You will be able to track the highs and lows (hypoglycemia), trends and patterns, and hopefully make healthy changes accordingly.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.