I was just reading up on Kerri’s recent blog entry and I’m afraid she isn’t that unusual when you look across the broad range of people with diabetes. She’s busy and diabetes tends to take a back seat until something serious comes around.

Here are a few suggestions for Kerri and the millions of people with diabetes like her:

Make sure you never go more than 3 months without getting your A1c.

With our HomeCheck kit you can get the highest quality A1c available in about 3 minutes from home. Just order online and mail it in. Voila - you now have a pretty good idea how things are going (vs last time) and can use that info to nudge yourself in the direction of your friendly neighborhood physician for your regular appointments as needed.

Bernard Farrell did a video review of our HomeCheck and posted it online at his blog here with the video shown below hosted on YouTube:

Find a way to easily track and identify blood sugar trends.

You can use a GlucoMON to automatically handle your logging and generate reports that allow for easy identification of blood glucose trends and to perform pattern analysis.  People who use the GlucoMON say that this only takes them about 1 minute a week with the GlucoMON when it used to take them 1 hour each month before.

And because it’s so easy they are actually managing this information on a weekly basis vs monthly.  Better information leads to better choices. You can read a GlucoMON product review by David Mendosa here and then subscribe or click on the link to his complete review at healthcentral.com

Leverage the power of the diabetes community as you seek reimbursement for new diabetes tools.

If you are going to pursue use of the new continuous glucose monitoring systems, you will most likely need to fight your insurance company to get reimbursed.  Fortunately there is an online resource sponsored by Diabetech called CGMSCENTRAL located at

http://cgmscentral.com  Everyone going after reimbursement one at a time is a very slow process. If there was a way to share information amongst the entire community the process of successfully securing reimbursement will go much faster. To be armed with knowledge is to be armed.

What else do you need to simplify diabetes?

If there are other areas of diabetes care that need simplification you should comment below.  After all, if you want things done you might as well tell someone (Diabetech) who has a track record of delivering a simplified version of diabetes care.

(psssst…. Kerri if you read this give me a call and I can set you up for a trial and see if we can make it easier for you to regain those good habits.)

One of my favorite movies growing up (and even as an adult) was The Wizard of Oz. I learned many lessons about life from its symbolism. Without question, the most profound message I learned was that inner peace and happiness are never found “over the rainbow”, but in our own back yards (faith, family, and personal relationships). It was only at the end of her journey through Oz that Dorothy realized she always had the power within her to return home (to family and happiness). The magic of the ruby slippers in truth resided within her. But first she had to believe; not in the slippers, but in herself.

That message has resonated with me over the years regarding many other aspects of life. I see a very strong connection between this human truth and how we manage diabetes (and that of our children).

Let’s face it. Many diabetics are always looking for an “over the rainbow” solution to our blood sugar control problems; a “knight in shining armor” to come rescue us from the diabetes “dragon”. Our ruby slippers may be the latest blood sugar meter, some new diabetes care tool, a state of the art insulin pump, a new pill, or a new investigational therapy that might just “cure” our diabetes altogether.

But disappointment, rather than satisfaction, is what we often seem to find. Over my nearly half century of living with diabetes, I’ve seen countless new diabetes tools and gadgets marketed on hope and anticipation. Virtually none of these tools have removed the need for me (or my family) to take an active and responsible role in daily diabetes self care.

The hope that a diabetes “cure” is just around the corner has been dangled in front of me or my parents for over 43 years. Plus, it’s always just about “5 years away”. Don’t get me wrong. I still believe a cure will come. Maybe not in my lifetime, but I’m as hopeful as the next person. However, I’m also a realist. We make our own destiny as far as diabetes is concerned. It’s all about our choices.

But is the problem with our technology or with us? At some point we (hopefully) realize that our diabetes fate is in our hands. Oprah Winfrey has aptly coined a term for this sort of epiphany: the “ahah” moment. The point of true clarity where you see what your life challenges really are. And they’re not necessarily what you’ve been thinking about all along.

Diabetes control is not a thing, but a state of mind…a way of living. You can’t save up a “bucket” of good diabetes control to live off of during hard times. In the end, good diabetes control is the sum of your choices made each day. It starts from when you woke up this morning and exists until the minute you fall asleep. Actions you take or don’t take matter equally by my argument. First among those critical choices is finding a doctor to care for your diabetes. Next is embracing the concept of diabetes self management education. Diabetes is a condition you live with. It’s the tiger in the room you must tame; otherwise you will be consumed by it.

How each person chooses to manage their diabetes (or not) is unique. The barriers to good care are often those we place before ourselves. The greatest contributor to why we often fail is ignorance, followed by fear, and then denial. Sadly, these traits can be passed down from generation to generation. Self care behaviors (both good and bad) can perpetuate themselves within a family setting; at least until someone stands up and challenges the “status quo”. I’ve found that the traits and qualities a person uses to solve the other challenges in life often get applied to how they approach their diabetes self care.

Like Dorothy, those who succeed and conquer their diabetes are the ones who realize and accept that they have been wearing the “ruby slippers” all along. They reject diabetes as a “fate” or “destiny” and refuse to submit to it. They use the God-given powers of choice to learn more about their diabetes and continue learning. They also understand that in the end diabetes is a marathon and not a sprint. The changes they make in their lives must be long lasting, not just temporary fixes. It’s the power of choice that separates us from all other life forms in this world. We all too often abdicate that very precious power when we are confronted with a challenge like diabetes.

So next time you look in the mirror, realize that it’s you who is in charge of your diabetes. Only when this “ahah” moment occurs will you have turned a corner in your “life lived well” with diabetes.

To read yet another version of the diabetes - Dorothy analogy go here.

Beyond the headlines:

- when walking alone
- at night
- in a dangerous neighborhood

A few weeks ago, headlines in the British newspaper The Daily Telegraph blared out that at home self testing of blood sugar levels could be detrimental to diabetics. The story went on to say that thousands of diabetics could be doing themselves more harm than good by testing their own blood sugar levels. The story was based on a 2008 study reported in the British Medical Journal which discovered a 6% higher score on self-reported measures of depression in adults with newly discovered type 2 diabetes (Additional details from a review by the National Health Service here).

 The purpose of this research was to investigate connections between self-monitoring of blood sugar, overall diabetes control, and a patient’s mental health. The researchers concluded that overall diabetes control over the one year after diagnosis of type 2 diabetes was not different between groups who checked their blood sugars and those who did not. Even though diabetics who checked blood sugar reported slightly higher feelings of depression, this was not associated with any higher levels of anxiety, lower energy levels, or reduced levels of well-being.

Another report released at the same time reported what many would consider a pretty obvious conclusion: that the costs of diabetes care are almost twice as high for diabetics who monitor their blood sugars frequently compared to those who don’t.

So what does this all mean and how should we react?

First, don’t go toss your lancet and meter device in the trash just yet. This study looked at a very narrow group of all patients with diabetes and the results shouldn’t be generalized to everyone.

Home Glucose Monitoring Is Only A Tool

And a fantastic tool at that. But like any tool, it is no better than the person who wields it. Self glucose monitoring is invaluable to type 1 diabetics who take insulin and are striving for the best possible diabetes control. Frankly, anyone who is on insulin therapy for any reason should be checking their blood sugar regularly. This study only targeted a specific group of patients: the newly diagnosed type 2 diabetic. There are some characteristics that you should understand about these individuals to better understand why they came to the conclusions they did.

At the time they’re diagnosed, most people with type 2 diabetes have permanently lost about half of their pancreas’ ability to make and release insulin (the hormone that controls blood sugar levels). That ability is never recovered. Losing the rest of that ability is what slowly happens over the rest of the life of the person with type 2 diabetes. Good control of the diabetes may slow down how fast the remaining 50% goes away.

After this story went out, it sent a mini shock wave through the diabetes world. Calls started coming in to doctor’s offices as to whether they should pitch their glucose meters or if checking blood sugar was now somehow hurtful. But like many headlines, they’re written to primarily grab attention more than to really inform the public.

Self monitoring of blood glucose (SMBG) was first made available in the 1970’s. Until then, diabetics could only indirectly check their sugar levels by measuring the amount that spilled over into the urine over time. While it’s helpful, this was a crude method to measure diabetes control. But ever since it was created in the early 1930’s urine testing was the best method we had. Urine sugar results were expressed as percents or colors on a chart. The goal was to allow the least amount of sugar to spill into the urine, preferably none. But blood sugar levels could be almost twice normal before any sugar showed up in a urine sample; this is hardly a way to keep someone in the best possible control of their blood sugar levels based on what we know today.

Early blood sugar meters required large amounts of blood compared to today’s devices. The measurement could take up to several minutes to perform, compared to the few seconds that today’s meters need. Meters lacked memory chips and required the user to write everything down, or the information would be lost forever. Because of the need for sugar levels to make smart insulin adjustments, the most enthusiastic adopters of glucose monitoring were those with type 1 diabetes.

Today’s glucose meters take extremely small amounts of blood (a fraction of a drop) and the samples can be collected from areas of the body other than the fingertips. Readings are available within 5 seconds and the results are stored in a memory chip to be downloaded later at the user’s convenience. Without a doubt, checking blood sugar levels at home has never been easier.

But measuring blood sugar readings is only half the job. For that information to be helpful to your control, it needs to be used to make better decisions about diabetes self care. The reason why so many studies have failed to show a direct benefit from blood sugar monitoring is that the information that is gathered by this process must be used in some constructive way if there is any expectation of these data helping better control the person who gathers them. If you are not the one who is responsible for this, then your doctor or diabetes team should be.

These days, many doctors may direct the patient to check their blood sugar several times a day; usually before meals and at bedtime. While most patients will do this for a while, others may struggle with this since they feel the act of blood sugar monitoring is uncomfortable, doesn’t seem to make any difference at all, or is even pointless.

Study Conclusions Were Wrong

Or, the real findings took a back seat to someone’s desire to grab headlines? Here is the reality check raised by that British study. It only focused on blood sugar checking in one group of people with diabetes, namely the newly diagnosed adult with type 2 diabetes. Persons with type 1 diabetes (where insulin is needed to survive) or persons with long standing type 2 diabetes requiring insulin treatment were excluded from this study. So, it’s wrong to apply these conclusions to all diabetics.

In all my years as a diabetes doctor and diabetes educator, I’ve found that when patients have a clear understanding of why I ask them to perform a self care behavior, they are far more likely to keep doing it. I also make a point to explain to my patients that I don’t take care of anyone’s diabetes (except my own, of course). Ultimately, it’s the person with diabetes who makes all the numerous choices and decisions every day that make up their overall diabetes control. I go on to explain that the doctor and diabetes team’s role is to educate and motivate patients to understand how to best take care of themselves. It truly is the sum of their choices each day that determines the overall quality of a person’s diabetes control.

The act of collecting a blood sugar reading will only help if someone (hopefully the patient) can use that information to make better self care choices. But choices based on training and diabetes education are far superior to choices based on ignorance or random guesses. Sadly, today many diabetic patients never get the necessary education and training to fully benefit from self blood sugar monitoring. And even when some do get that basic training, many choose not to apply it in their daily lives with diabetes.

If that extra work to check blood sugar doesn’t feed back to the patient in a positive way, then it is reasonable to question why it should be done.

Many diabetics have the wrong attitude about their blood sugar results. Many may tend to think of the readings as “good” or “bad”. Unfortunately, health care providers can fall into the same trap. A blood sugar result is simply a number; nothing more, nothing less. There really should be no place for value judgments. You can’t “study” for a blood test and you can’t “will” your blood sugar into submission.

Control of diabetes is more a pattern of behavior than what kind of equipment or medicines you use.

If patients are unable or unwilling to track their own readings and learn to analyze them, then glucose monitoring will not be very helpful to the patient. When the patient sees the doctor, only then might a change in management be made based on the doctor’s quick analysis of the results. If the doctor doesn’t encourage home sugar checking (and some do), then it’s not surprising that overall control is unlikely to improve or reach a mediocre level at best.