Bad Habits in Diabetes Care

Dr. C's response: The latest scientific literature based on continuous blood glucose monitoring strongly suggests that bolusing before meals and snacks will markedly decrease the variability of blood sugars and allow you to be proactive rather than retroactive. It is very clear after looking at sensor downloads. However, realistically, given the constraints of schools, eating behavior of small children etc. it is not always possible to bolus before eating. Therefore, I would suggest trying to bolus before eating as much as possible at home. If it is difficult to know how much one is going to eat, I would suggest to bolus the amount required for correction immediately and then add the food bolus in the middle of the meal. If you do not bolus before eating, there is a greater tendency to forget and then you are trying to catch up later with those high blood sugars.

IMPORTANCE: 9

Logging Blood Sugar Numbers

For years we were diligent in writing down every number. Then when my son started pumping it gave us new motivation to be diligent in our record keeping, but now, six years into diabetes and four years of pumping later, we rarely log the blood sugar numbers. Yes, I do the pump/meter download the night before our endocrine appointment or if the numbers seem really out of whack. I'm always impressed with how helpful it is to see the numbers, the patterns, and how much easier it is to tweak basal rates when the data is staring us in the face. But the day to day logging of numbers...we are so over that . . . unless the A1C creeps up.

Dr. C's response: I am "so over" written logs as well (especially if the numbers are fabricated). My exception is if someone does not bring in his meter to download or does not download the pump/meter the night before his diabetes visit. It is a good idea to write numbers down to see daily patterns. And, suppose the computers decide to have a bad day? We appreciate it enormously if you bring in all the meters for us to download so that we have an accurate picture of what has occurred during the last few weeks to three months.

IMPORTANCE: 6

Testing Too Much

Some parents may argue there can be no such thing as testing too much, but I think there are some real issues with overzealous blood sugar testing. We test about seven times a day. I once tried to just test five times (before breakfast, before lunch, before dinner, bed time and 11 pm) but couldn't do it. We needed to do a test before the after-school snack, and I couldn't let him play a sport without a test before the sport. We also check one to two hours after any blood sugar correction is given. Could we really go one whole day with just four to five tests? I don't think so. Seven tests may sound excessive, but I know families that get up to 12 on a regular basis. Please get them a CGMS!

Here's a question I tend to ask myself - am I asking my son to test to keep him safe, or am I testing for my own piece of mind? Both are valid but the latter may give me pause to consider if the test can be delayed. Is there ever a problem with too much testing?