Do you remember growing up and studying for the weekly Friday spelling quiz? You would receive the word list on Monday; each night you would spring into action, review them and then get tested by your parents. On Friday morning on the way to school you would have your last mock quiz before the real one; you were really prepared. In certain situations proper learning is achieved through constant repetition. Since it is spring, I thought I would touch on some familiar topics. I hope you will think this information is valuable. Long live repetition!
- Track Your Blood Glucose Levels – Seems simple, but many patients become complacent and decide they “do not need to test their blood sugars anymore” since “they are always the same.” Other patients use the guess method – knowing if they have high or low numbers based on symptoms. I just treated a patient who said “it was a bother to test.” Her blood sugars were inching up without any symptoms. She was diligent about getting tested at the physicians’ office for A1C’s, and to her surprise her A1C went up 2% – from 6.8% to 8.8% from her previous visit! Sometimes high or low blood sugars can exhibit the same symptoms. Often patients have no symptoms which can be even worse. A recent study done on over 20,000 patients with diabetes revealed that frequent testing led to a lower 3 month A1C value. This was published in Diabetes Care Journal, and because of the results, insurers have lifted some of the restrictions on test strip allowances per month. Check with your physician and insurance plan. Buy extra strips out of pocket at a fair price. If you take multiple shots of insulin or wear a pump, you may need to test as many as 6-10 times a day to get it right. Most portable meters are simple to use, easy to read and the results can be downloaded to help you and your physician make informed decisions about your diabetes treatment. If you have vision problems, get a talking meter or one with a back light and large display screen. Try to vary the testing time. Do not stick to testing only first thing in the morning unless recommended by your health care provider; that reading may give you a false sense of security. By testing 2 hours after a large meal you may find your highest readings; then you can finally address them (the A1C consists of both fasting and post-prandial readings). During medical visits patients are routinely astounded by their readings after a meal. Review and refresh proper meter use/technique and change the lancet to give you a clean stick each time. Use the side of your finger, not the pad which has the most nerve endings and could cause pain. Remember to bring your meter to the physicians’ office to compare lab readings. Numbers need to be within 20% of those lab results. Use the information to make a change, not get upset. Remember to supplement daily blood glucose testing with an A1C test every 3 months. You can purchase a home A1C kit which is easy to use if you feel you want to know the results prior to your scheduled physician appointment. This will give you the 3 month average which indicates how well you are being controlled (look for 6-7%, or discuss the best reading for you if you are elderly with cardiac disease), and your risk for future micro-vascular complications. Dispose of lancets properly.
- Always Be Prepared for Hypoglycemia – The ADA and the AACE (American Association of Clinical Endocrinologists) recently developed new guidelines for clinicians relating to hypoglycemia (low blood sugar) of blood sugars 70 or below and the basic message is – “It is real, it happens to both people with type 1 or 2 diabetes, and it can be very dangerous if not treated.” People can easily get into a car accident, pass out or fall and break a bone. Studies have shown that hypoglycemia can raise the risk of a heart attack in elderly patients. Your physician may now include a ‘hypoglycemic questionnaire’ to see if you are at increased risk. The easiest thing to do is be ready by carrying glucose tablets. I often have patients insist that this is their time to inhale chocolate or cookies to elevate blood sugars. This leads to weight gain and rebound hyperglycemia. Glucose tablets offer a fixed amount of carbohydrates (4 – 5 grams per tablet) with a certain amount of calories (15 per tablet), and they are reasonably priced. This helps your blood sugar rise in a reliable way without over treating or over eating. Carry extra carbohydrate snacks with you as well.
- Know Your Equipment – Technology makes life easier but can be problematic if you are unfamiliar with how it works, and what you need to maintain it. Know your equipment’s operation and check which batteries your machines may require; keep extras around. I have often known patients who could not use their diabetes equipment due to dead batteries; this obviously can become a safety issue. Check for battery types and sizes in each machine. Keep batteries in the freezer to stay fresh. Have extra supplies for pumps or CGM (continuous glucose monitoring) devices as well as extra insulin, syringes, needles and pens. With good planning you will be able to prevent a crisis.
Get started with your spring into diabetes action plan. Decide what help you need and plan ahead. I will continue with more basics in our next newsletter. Enjoy!
NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.
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.
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