Understanding patterns can steer you in the right direction
Keeping records and downloading reports from your meter, pump or continuous glucose monitor (CGM) can help you see the big picture. You can use these records or reports to see patterns in your blood glucose levels. Sometimes it is not always easy to see a pattern so your healthcare provider can educate you on how to best analyze your particular readings. It’s recommended that you check your blood glucose for 3 or more consecutive days, prior to each meal and before bedtime, so that you can gain a complete view of your particular patterns.
Breakfast Lunch Dinner Bedtime
100 88 220 160
But if you have several days of blood glucose numbers then you are able to see if there is a pattern.
Breakfast Lunch Dinner Bedtime
100 88 220 160
85 220 60 260
98 127 140 267
77 130 102 202
It’s helpful to circle or color code the numbers that are out of your target range then ask yourself do you see a pattern? If there is a non-desirable pattern you might want to figure out if there is a cause. Write down everything you can that may have an influence on your blood glucose. For example doses and times of your diabetes medicine, times of your blood sugar numbers and foods you ate.
Please talk to your diabetes educator or healthcare provider and ask for suggestions on changes to keep your blood glucose closer to your target range.
When using 3 or 4 days for pattern management it would be a good idea to not include blood glucose numbers collected during an illness or major emotional stress, at the start of a menstrual cycle or after a low blood sugar.
The American Diabetes Association suggest the following blood glucose targets for most non-pregnant adults with diabetes:
- 80-130 mg/dl before a meal
- <180 mg/dl 1-2 hours after a meal
Just remember this takes time. It’s not a judgment of you as a person, but rather an adjustment in your diabetes treatment plan.
Hollie Breedlove, MS, RD, CDE
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