One of the 64-million-dollar questions in the diabetes world is why more of us don't do a better job tracking our blood sugars.
I know that's been a key question in my 28 years of living with type 1.
Fitting with the behavioral change theme of this year's ADA Scientific Sessions, and how doctors can motivate us to "do better," a breakfast session explored the issue of BG logging and why it's such a challenge for many of us.
An all-star trio of endos discussed this topic for more than an hour: Dr. Bruce Bode in Atlanta, Dr. Bill Polonsky in San Diego who leads the Behavioral Diabetes Institute, and Dr. Ralph DeFronzo from San Antonio. Hosted by Abbott Diabetes, the event eventually came back to the new Freestyle InsuLinx meter and how it could be used to help PWDs better track their BG data.
While the reality was this was a product pitch in many ways, the thought-provoking talk with these experts was really something I enjoyed — particularly since I'm someone who often slacks on BG logging and regularly hears about it from my frustrated endo!
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A slide that caught my eye with colorful pie charts showed some interesting stats: 36% of insulin-using PWDs don't log their test results, 46% still use paper logbooks, and only 18% use e-logbooks — all based on about 1,000 type 1 and type 2 PWDs surveyed in May 2011.
For insulin-dose tracking? More than half don't do it. Nearly a third use paper logbooks, and 17% use e-logbooks.
Written records versus computer downloading... that's not even the issue — it's the number of people who don't bother tracking at all!
Why Don't All PWDs Log Faithfully?
Some of the common reasons the panel trio identified against BG logging: it's inconvenient, and time-consuming (despite the fact that you can discreetly do a BG check in less than 30 seconds).
Also, Dr. DeFronzo said that he frequently sees patients who'd rather have their doctor feel good about BG results, rather than using logs to inform themselves about what's actually going on.
Yup, often we patients feel that BG checking or logging isn't worth the effort either because we don't know how to act on the data or because we find it "bad," frustrating, and discouraging. The results are seen as statements of our worth, not just numbers and information you can act on.
Dr. Polonsky, resident expert on the psychological side of diabetes, said, "There's an emotional valence attached, and it's hard to get motivated to test and log when that's how you feel."
He's studied the trend and found 81% (!) of PWDs asked about why they don't test more responded with: "If the reading is high, I blame myself."
This resonated with me to the core; to this day, I do that every time I see a high BG. After, of course, I swear at my meter and shake my head.
I've always been this way, but in my younger years I tried to hide my results. As a teen, I just didn't want to "disappoint" my parents or my endo by having "bad" BG numbers... so I would make them up. That was easier and made me feel better, even if I was only kidding myself and couldn't get past the truth of my A1C, the three-month average that wasn't impacted by whatever my paper logbooks said. At some point, I learned that the meter could disprove what I said and so other tricks came to light, like using only half as much blood to get a lower result that I could flash around as proof I wasn't lying.
Basically, I always assumed that those "horror stories" about losing limbs and worse became a likely reality in my mind, and led to a "Why Bother?" attitude where I just didn't care. I wanted to be "normal" and live my life, not be defined by that big bad D that would probably kill me. I lost hope, for the most part. And a consequence of that was not testing, and then trying to convince everyone that I was doing OK so they wouldn't bother me (lame, I know now!).
I bring this up because apparently despite all the new technology, there are still kids and teens out there who will go to any length to disguise what's really going on with their D-management. Bode told a story about one teenage girl who went as far as using her lunch money to persuade friends at school to prick their fingers for 25 cents a poke, giving her the ability to fake "perfect" BG results right in her meter's memory. And that's just how she described it to Bode, despite the 12% A1C that proved otherwise.
Clearly, you have to want to check BGs and log that information in whatever format works best.
Interestingly, Dr. Bode said he requires his patients have a meter that can be downloaded in the office, and if a PWD doesn't bring that meter - or maybe the paper log book - with results, the person is sent home!
"Because if they don't have that, I can't help them," Bode said. "What am I going to do? Just socialize with them?"
Seriously?! Seems a little harsh, doesn't it?
An endo in the audience later made the comment, "You don't go to the dentist without your teeth, so why would you come to us without your blood glucose results?"
Polonsky said he at first felt a little queasy when hearing about that ultimatum. But after reflecting on it, he understands the reasons: because BG data is at the core of what endo visits are about.
Personally, I'm not convinced just sending someone home is the best idea. My endo may not be able to make any changes or determine how I'm really doing, but we can examine whether I'm going through burnout or something else that's standing in my way of wanting to test and log data. That's valuable.
An informal survey of the medical pros in the audience had few people raising their hand when asked if docs are downloading data in offices, and that's not even getting to the whole issue about charging for this service. I've heard some in the Diabetes Online Community say their endos offices tag a fee for downloading data, where others (like my endo) do not. There's no consistency on this trend.
"Whatever Works" Is the Answer
The docs said removing time burdens and inconveniences can help, but so can having more interaction and time in the doctor's office to discuss what the BG results really mean -- in an interpersonal, patient-friendly kind of way. Easy-to-interpret summary data to help inspire PWDs to keep good records is one option, they said. Polonsky pointed out the psychosocial aspects are important, and his clinic gives out stickers to remind patients that their BG numbers are just that -- numbers, not statements of self-worth.
I actually do best when I'm writing my BG results down by hand, right when they appear on my meter screen. That gives me a sense of accomplishment and keeps me accountable, being able to see how it compares not only to the past hours but the same times of recent days. For me, it's just not the same to have to plug that number into a device and see it on a computer screen, regardless of how "easy" that may be. Call me old-school, but that works best for me.
Obviously, Your Diabetes May Vary and it seems that many do best with a connection cable or wireless link putting their BG data onto a device that can then be downloaded and transmitted to their doc or CDE. Again, whatever works.
Honestly, I think it comes down the individual person wanting to check BGs and track that information. If that means finding motivation outside the endo's office, or finding a better doc-patient relationship that includes better conversation, then I'm all for it.
In the end, we may not necessarily be defined by our numbers, but they are the bread and butter that get us to whatever definition of success we're shooting for in our D-lives.
Anybody out there have any motivation tips? What works on best on long-term logging for you all?