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Dr. Bill's Commentaries

Why to check your blood sugar   (August 13, 2007)

After I posted an essay on Times to check your blood sugar, a reader very correctly pointed out that "The problem with the testing advice offered by many doctors is that they don't tell their patients how to make good use of the results."

I completely agree: unless the patient knows what to do with the blood sugar results, it's wasted time and money. The reason to test is so the activated patient can use the data to think through what's going on, and what changes might be implemented, to get better control.

An example: Let's assume that a patient has a blood sugar before breakfast that's always normal, and a blood sugar before the noon meal is always high. The patient has some choices about what to do. The patient could:

  1. exercise more in the morning
  2. eat less at breakfast, or skip a mid-morning snack if it's been routine
  3. look at whether there's some high-stress event that regularly occurs in late morning and is kicking the numbers up: if so, perhaps rearranging the stress to another time of day would help. Sure, for many stresses, that's not possible, but it's sure worth evaluating if stress is part of the reason for the high numbers
  4. if taking insulin, increase the morning dose of rapid-acting insulin; your physician or diabetes nurse educator should have advised about how much to adjust. (Sadly, there's no easy way for patients taking diabetes pills to adjust their doses unless on the very short-duration pill called Prandin.)

Another example is important to patients who have a propensity to hypoglycemia (which is just about anyone on insulin, and most folks on diabetes pills): Check

  • If you think you are having low sugar symptoms.
  • If anyone thinks you are having low sugar symptoms.
  • Before driving an automobile or operating other dangerous machinery. And if you're on the low-side, eat before putting the car in gear!
  • Both immediately before, and after, active exercise. (Also, if you have the chance, check an hour before the exercise).
  • At bedtime.
  • At about 3:00 AM.

Obviously, if the number is low, then it's time to eat - and to think through "Why was I low?" (was it unexpected exercise, a missed meal, or a bigger-than-average dose of insulin?) And if it's low at bedtime, there's a high risk of nocturnal hypoglycemia, which should be countered by eating a bigger-than-usual bedtime snack.

Other times to check relate to the possibility of high blood sugar, and the need to adjust your diabetes medications to bring things back into better control:

  • If you are ill. (Be sure to check several times daily; if the results are higher than usual, call for advice!)
  • For at least 3 days after any doctor changes any of your medications.
  • At least 4 times a day during hospitalizations.

In any of these situations, if the numbers are high, you and your doctor should trouble-shoot your medication program, and adjust something to get better numbers.

Also, there's always the chance that you simply don't know what's going on with your body and it would be good to know. For example, maybe you've been driving an automobile for a few hours (or have been a passenger) and are getting "highway hypnosis." Besides stopping to stretch, and get the kinks out of your muscles (and prevent blood clots from forming!), check your blood sugar and see where you're at.

So, don't just check your blood sugar. Use the information you've gathered!

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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

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