Ask The Expert
Monitoring

It is a very good thing that you are keeping such a keen eye on your overall diabetes control!  The reality is that your doctor has only a limited amount of time to spend looking at your glucose records; however, by using all the resources and tools available to you, hopefully you will be able to maximize the benefits of glucose testing, gain a better understanding of the factors that affect your control, and discover ways that both you and your diabetes team can evaluate your diabetes in the most efficient manner.  I will explain each of these briefly, and then I hope you will read the related questions and links for more detailed information.

The tools and resources I am referring to are:

• The A1C test
• Testing at various times of the day
• Using a data management system
• Keeping a detailed log book for 1-2 weeks before your visit with yourdiabetes team
• Working closely with your diabetes education team on a regular basis

The A1C test:

You did not mention your A1C result. This is a blood test that indicates your overall blood glucose control over the last 2-3 months. It is generally recommended that people with diabetes have the A1C test approximately every three months. Please be sure to read more details about the A1C test in the related questions provided at right. In addition, your doctor may want to focus on results of the last few weeks to get an idea of where your blood glucoses have been running most recently.  These readings help your doctor decide if diabetes medication is needed, as well as what type of medication to use, since there are many different categories of medication that target all the various problem areas in type 2 diabetes.

Testing at various times of the day:

Why should you test on a regular basis? Because monitoring your glucose tells you how you are doing and helps you to spot problem areas that need addressing. Testing at various times shows you how your body responds to different factors such as physical activity, meals, snacks, illness, and stress, along with how your blood glucose level is maintained overnight.  For example, if your A1C is too high, it may be hard to pinpoint just where the problem is.  By varying your testing times, you can see where you need to take action.

• For instance, if the glucose is high two hours after meals, your team may be able to prescribe medicines to target the post-meal glucose, or they may ask you to exercise after a certain meal; in addition, your dietitian may analyze your carbohydrate intake to see if it needs adjusted.
  
• If your glucose is only high first thing in the morning, then your team may suggest modifying your evening meal or snack, or perhaps adding a medication that targets the fasting glucose.

Using a Data Management System:

An easy way to find those problem areas would be to use a data management system with your blood glucose meter.  Data management systems provide a variety of graphs and charts to help you identify the problem areas that need to be addressed.  You can view your data on a computer, email it to your healthcare team, or print the data and bring it with you to your healthcare visit. These graphs and charts help you quickly spot where help is needed during the day or night, as well as to differentiate pre-meal vs. post-meal glucose levels.  While data management systems provide a complete summary of your tests, you can also change the date range to look at more recent tests, or look at a summary of tests over 3 months or longer.  So while your doctor may only have time to concentrate on the most recent 2 weeks of detailed data in your logbook, he can see a fuller picture if you provide the data management summary for the previous 3 months.

Abbott Diabetes Care provides such a diabetes management system called the CoPilot™ Health Management System; this system is compatible with all the FreeStyle® and Precision Xtra® meters. Be sure to explore the related link below to learn more about data management.

Keep a detailed record for a few weeks before each appointment with your healthcare team:

While a data management system can help you quickly spot trends and areas that need improvement, it may not provide all the details surrounding a particular problem area unless you have manually entered your food, activity, medication dosages, and state of health. That is why it is common for your diabetes team to ask you to keep a very detailed record for a few weeks prior to your appointment, so they can concentrate on that period to analyze your routine more thoroughly and suggest modifications as needed.

Work with a diabetes education team on a regular basis:

All the things I have mentioned emphasize the importance of seeing a diabetes education team, because each member of the team looks at different parts of the diabetes picture.  

• Dietitian:  After you have kept a detailed food record for 3-7 days, the dietitian can analyze your meal plan for carbohydrate, protein, and fat content. Furthermore, she can help you with challenges such as meal planning, dining out, eating on the run, holidays, etc.
  
• Nurse educator:  Your diabetes nurse educator can help you understand all the aspects that are involved in diabetes care and work out an individualized self-management plan that best meets your needs. As you mentioned that your doctor may put you on pills, the nurse educator can help you understand why this is quite common, and can explain how the various diabetes medications work.  

Since your glucose numbers are not yet where your physician wants them, I hope you can employ some of these ideas to better understand how to get your blood glucoses into target.  Be sure to talk with your physician and other healthcare team members to determine what suggestions are right for you.