Many of my patients understand the importance of monitoring their blood sugars. Many will even write them down and a few will even remember to take them to their diabetes visits with their physician. When I start discussing pattern management with my patients they often give me a blank look. After checking their blood sugars, they seem to know very little about where to go from there.
What do these numbers mean? What is the purpose beyond “that’s what my Dr. wants me to do?” Pattern management is not something that physicians often have the time to teach at their 10 minute encounters, and is one way in which CDEs can be very helpful. Sitting down with a patient and reviewing blood sugar records is of vital importance for patients to better understand their diabetes.
When looking at a blood sugar record keeping it well organized is key to making sense of the maze of numbers. It’s also very important to write the blood value in relationship to a meal. Was it before a meal? After a meal? 2 hours after or 10 minutes after? All these details are very important to understanding a glucose log and working to finding patterns. I’ve found many of my patients will write the time of day they check their blood sugar, but it’s impossible to tell if this is before breakfast, after breakfast, after exercise, etc. These details are so important to pattern management.
I always ask my patients to give me a good idea of their fasting numbers. Once they’ve established a good range or their individualized range, then we typically move on to testing 2 hours after the start of a meal. Also, I ask them to vary the meals they test after to give added information. I have them write all of their values down and return to me for follow-up. When the patient walks in my office we work to begin to “decode” the log. We look at reasons a fasting number might have been high. Next, we look at after meals and evaluate what was eaten to decode the “spike” after dinner. We also look at how stress and exercise affected the numbers.
I can almost see their eyes opening and they begin to understand those numbers versus just writing them down. They start to understand why it was lower and why it may have “spiked.” Those “light bulb” moments are the reason CDEs do the work they do and with passion. Teaching patients to begin working to manage their own disease is the goal. Decoding the numbers and working to understand their diabetes better is rewarding for them. For a patient to really understand why they are checking their blood sugar and what the purpose of each number means helps motivate them toward better care.
I think that sometimes as educators we get caught up in the things we “need to teach.” I find that pattern management is always something we can touch on with our patients no matter the duration of their diabetes or where they’re at now. It’s all about baby steps. You may ask them to begin testing once a week and move up from there. It may not always be the smooth process we envision, but be sure to focus on their accomplishments with their diabetes care. Just the fact that they came to see you shows they’re motivated toward better care!
Jessica Miller, RD, CDE