Montioring Blood Glucose levels, and records...


(copied from the old board)

Posted by DJ
22 Apr 2003 : 8:12:12 PM

This is excerpted from a handout about "Monitoring BG Levels" that contains excellent information, by Ms. Sherri Shafer, RD, Certified Diabetes Educator.

Click the link at the end to read this informative (and lengthy) article, or to access Sherri's archives, (beneath her picture, on the left side of the screen).

It's ok to copy the material in toto; they intend it to be printed as handouts to DMs.


The <font color=red>portions set in red script are my comments. </font>

dj


When to test BGs:

The optimal time and frequency of SMBG (self-monitoring BGs) depends on the patient's age, type of diabetes, type and timing of medication, co-morbidities, treatment goals, and history of glycemic control.

Suggested times to check blood glucose:
<ul>
<LI> Fasting blood glucose.

<LI> Before meals.

<LI> 1-2 hours after meals for peak postprandial value.
&lt;/ul&gt;

&lt;u&gt; Before and after meal blood sugar checks are important to show the response to the foods eaten: &lt;/u&gt;

&lt;ul&gt;
<LI> Occasionally, check at 2-3 AM, to ensure that medication doses are correct, and/or to expose nocturnal hypoglycemic episodes that may be going unnoticed.

<LI> Before and after exercise to see individual response to various forms of activity. This check provides the DM1 information for adjustments to the insulin regimen, & DM2's find it rewarding to see how exercise can improve blood sugar levels.

<LI> Before driving a car (for anyone on insulin or oral hypoglycemic agents) -- this is especially critical for teens, and for anyone with hypoglycemia unawareness, or who has a history of low blood sugar.

<LI> When experiencing symptoms of hypoglycemia.

<LI> When drinking alcohol, given the increased risk for hypoglycemia, because alcohol inhibits gluconeogenesis.

&lt;u&gt;
<LI> Increase the frequency of monitoring during illness.

<LI> Increase the frequency of monitoring to assess changes in therapy. &lt;/u&gt;

&lt;/ul&gt;


Blood glucose targets for non-pregnant individuals with diabetes:

Event Normal BG Goal Additional Action Suggested

Preprandial &lt; 110 90-130 &lt; 90, &gt;150

Postprandial &lt; 140 140-180 &gt; 180

Bedtime &lt; 120 110-150 &lt; 110, &gt;180

&lt;font color=red&gt; A light snack is essential at bedtime, even if you are not hungry. i've found it most effective to eat healthy fat and protein or a small kefir smoothie with pumpkin, coconut, flax meal, and stevia to taste (+/- 250 cal).

For non-diabetics,
preprandial readings are usually between 80-100;
postprandial (postmeal) readings are usually between 130-140 (unless they have really carb-loaded).
bedtime readings are usually between 80-100. i prefer to keep my levels as close to the non-diabetic ranges as possible because the blood glucose level is different is not the insulin level, which is &lt;5 (equivalent to approximately 90) in non-diabetics.

i can get non-diabetic premeal readings because i control with diet (and exercise when physically able). DM1s, controlling w/ insulin, and DM2s who control with oral glucose agents, probably cannot because of the danger of hypos, which i never have to contend with hypos unless i am too active for too long & have forgotten to eat.

i prefer for my bedtime reading to fall between 85-100 -- esp because i've been having trouble with DP (overnight glucose rise) since July, 2002.&lt;/font&gt;

&lt;u&gt;*Remember, individual targets should be established with the input of your medical provider.&lt;/u&gt; It may be prudent to set the targets higher for certain patient populations, such as young children given the risks that hypoglycemia can affect cognitive development, the elderly who are at risk for falling,& patients with hypoglycemic unawareness or other complications.

** The above values are plasma-referenced and expressed in mg/dl. (Most blood glucose monitors are plasma referenced. For meters that provide readings as whole blood values, the numbers would be 10-15 percent lower.)

*** If you are more familiar with millimoles per liter, you can convert mg/d to mmol/l by dividing by 18.01.

Record Keeping

No one can review a meter's memory, number by number, and make sense of the information. A written logbook offers the added benefit of organizing blood sugar readings into the various times of the day. This allows both patient and health-care team to see glycemic patterns. When a reproducible pattern is observed, a treatment plan can be instituted. I advise patients to call when they notice a pattern that indicates inadequate control.

Too often, patients check their blood glucose levels, write down the numbers (or not) without using the information to problem solve. Patients have to be taught what to do with the numbers, and when to contact their healthcare providers. On the flip side, health care providers must look at the blood glucose logbooks and interact with our patients regarding the numbers. Nothing is more frustrating for patients than to keep records and then have their healthcare team ignore the data.

&lt;font color=red&gt; If your team ignores or does not examine your BG logs, your DM care is inadequate, because learning to do this day by day and how to spot (and to correct) problem areas is essential to your well-being. The team's input to resolve questions or problems is absolutely necessary.&lt;/font&gt;

Computer printouts downloaded from the meter data are helpful; however, they shouldn't replace written records. If patients download their meter information on the day of the appointment, it's likely that they have not been reviewing their data on a daily and/or weekly basis, and they are less likely to see patterns of control.

&lt;font color=red&gt;
If you do log carefully, your records soon will ID the foods that help or hinder your blood glucose levels. It's a real chore to learn how to do it, but after you've mastered the drill, you'll reap the benefits in both the short and long term. (The long term benefit is avoiding the horrid things that can happen to DMs who fail to manage their condition well -- a long and most unpleasant list.

Too often DM caregivers say that the reason a treatment plan does not work is that the patient is not compliant -- either through lack of understanding {subtext -- stupid ; or deceitful -- lying about what they have eaten...} If you have done your best to comply, do not accept this rationalization. The team gets paid for your treatment -- see that you understand the whys and wherefores of your treatment plan. Insist on this, good care is your right, and his or her responsibility.
i promised to post this information weeks ago -- sorry it has taken this long. Next time, i'll type in the information from Joslin Diabetes Center.

Best wishes,
dj&lt;/font&gt;[]


http://www.diabetesincontrol.com/shafer/homemon.shtml

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les w
Posted - 13 Jun 2003 : 11:50:25 AM

Thank you for an excellent posting.
My pre-prandial readings are excellent (ave 95)but my post readings are not so good, often over 200 (even after a very lc meal). My Doc seems to concentrate only on pre-meal numbers.
I take glucophage. Before LC I used double the dosage of glcophage and took actos also.
Any advice?

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BrightLady
Posted - 13 Jun 2003 : 1:43:22 PM

DH is a DM1 on an insulin pump. With a few exceptions, he's able to maintain non-diabetic premeal readings. For all diabetics, the tighter your control, the closer you can stay to normal ranges, the better your chances of avoiding or minimizing complications.
Thanks for the post DJ. Again you're provided vital info.
Les, any medication advice should come from your doctor. As far as meal advice, are you following a low fat version of low carb? If that's the case your meal may still be hitting your system too fast or all at once. Check with your doctor if you can increase the good fats in your meals. Including high fiber veggies (raw is best) will help as well.

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DJ
Posted - 13 Jun 2003 : 3:41:57 PM

Les,
Bright told you right!
That said,
perhaps you can get your doc's attention in this situation if you log what (food and quantities -- no guessing -- measure or weigh each item), and do post-prandial) post-meal) checks at 1'; 2'; and 3', at least.
How are your Hb-A1c's doing? And your lipids?
It sounds as though your pre-meal checks are good; but as you can see from Bright's post, it's pretty important to keep your BGs in tight control -- and PP BGs at 200+ does not reflect tight control.
i have promised to post the Joslin Diabetic BG guidlines, and will do so next week after i get the new glasses...
Did your doc have you see a CDE (Certified Diabetes Educator? Your insurance will pay. Try to find one who is trained to counsel DMs who use the insulin pump -- most of them work with docs who use tightly controlled carb counts, and are far more aware of diabetic nutritional needs than regular dieticians (sp???). You need a consult in any case, but expecially if you are not terribly overweight...
Fiber, green veg & lowcarb/low glycemic fruit; healthy fat; fresh country eggs, lean fresh meat and whole milk kefir are what help keep my PPs in line, & the HbA1c's around 5.6
-- although i have been wrestling with Dawn Phenomenon (overnight glucose rise) since last June after a course of steroids for a medical emergency unrelated to DM.
Les, Best wishes,
HTH,
dj
PS: Let us know how you are doing.

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les w
Posted - 16 Jun 2003 : 1:38:08 PM

Thanks DJ and BrightLady- excellent advice.

Allow me to give a little more info. I have been type II for 12 years and have been getting by mostly with medication rather than good diet and exercise. I'm trying to correct that now.
Been on Atkins for 3 weeks now and having mostly good results(-14 lbs). My BG readings have gone down and I have been adjusting my medication accordingly. I spoken to my MD and he has warned me to measure sugar often and to see him as soon as possible. Unfortuneately he's booked for two weeks. So I am taking my readings carefully and my readings can be printed out on his computer and graphed.
In the past my Hb-A1C's have been good and my lipids are excellent (130)since I started taking Lipitor. Since I posted a few days ago, I'm seeing better readings 1 hr after mealtime, under 180.

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DJ
Posted - 18 Jun 2003 : 3:41:06 PM

Les,
180 is better than 200, but at Joslin Diabetes Center, they suggest 140 (@ 7.8)...
Another thing, FWIW,
i read last week that the 2' PP average is the index that most closely approximates the HbA1C...
To convert the US BG reading --
divide the test value by 18.01 (i,e.), 128/18.01 = 7.1
And to compare the HbA1c to the US BG (ml/dl) --
multiply the HbA1c value by 18.01 (i,e.),
5.6(18.01) = (@) 101
Another 10 lb gone will see a great improvement in your glucose levels, unless you have a bunch of weight to lose.
And don't forget one of the best tools for managing DM -- gentle, conservative exercise daily.
Other things that help??
lots of pure water;
adequate rest and sleep;
4 oz dry red wine / day;
--pure unprocessed lean meat (organic if feasible);
--45-60 g dietray fiber from green veg, low glycemic/high fiber fruit (such as blackberries & respberries)
--unrefined (cold or expellar-pressed) healthy fats, and plant fat food -- olives, coconut, avocado, mango (esp raw green mango, which makes nice salsas and/or chutney for wraps or meat, poultry and fish.
Congratulations on losing the 14 lb in 3 wks! May your glucose levels continue to improve.
Keep us posted,
Best wishes,
dj

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les w
Posted - 26 Jun 2003 : 1:35:42 PM

I promised an update.
Its taken awhile but I'm very happy to report that the pp spikes have just about disappeared. Two hr readings are almost always below 140. Lost 2 more lbs (16 in 4 wks).
Been following your advice, except for one thing. I now think I'm ready for those 4 oz. of dry red wine.
I'm going to let a bottle of Merlot breathe. It will go great with my Steak and buttered Broccoli at dinner. Gee dieting is tough!


grannycraft
Posted - 27 Jun 2003 : 09:49:06 AM

Does red wine really help? Would it help lower my BGs overnight?
I've been Type 2 for 7 years. I have yet to control my sugars. Been on every low fat diet imaginable and finally found Atkins again. (was on Atkins in 1972, lost 50 lbs the summer before my senior yr in HS). But this time around, I'm not losing nearly as much as I thought I should. I've been religously doing Atkins induction for four weeks now and have lost a total of 5.5 lbs. My BGs are 160-190 morning and pre dinner. But after reading this information, I think I should try testing more often. Also, I was on 4 insulin shots per day, 44 units of NPH at night, 28 NPH in am and Humulin as needed if BG before breakfast and Dinner were over 150. Plus, Glucophage and actos. Now I'm doing Glucophage and actos only. The actos lowered my blood sugar so much it seemed insulin was unneccesary, at least for 4 days. Then the BGs started climbing again even though I'm doing the atkins induction and haven't even thought about moving to the next phase. (I am 5'2" and 250 and my goal is 130). Any ideas would be helpful!

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BrightLady
Posted - 27 Jun 2003 : 4:23:44 PM

Granny & les, a little further down in this forum there's a thread called the importance of a bedtime snack. It talks about preventing the dawn phenomena which contributes to a high morning bg levels. I think you'll find it very helpful.

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grannycraft
Posted - 27 Jun 2003 : 5:07:13 PM

Thank you BrightLady, I'll check it out. BTW I love this site! I am so happy to find such a supportive group. I was feeling pretty much alone, even though intellectually I knew I wasn't.
les

[This message was edited by Brightlady on 09-15-03 at 08:09 AM.]

Hi there!

You've found an "Information Only" thread.

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Maggie
5'1" ~~ Atkins since '98 (160+)
Maintaining nicely (110 +/-)
~~ Redhead until further notice!