Bad Habits in Diabetes Care

Dr. C's response: Moderation is the key. My standard of practice is to test minimally four times per day. This is not enough, but with adolescents that may be all that you can get realistically. Optimally, I recommend testing between six to eight times per day depending on activity, food choices, illness, or stress. Twelve times a day is excessive and I worry about the anxiety that is provoking the testing behavior. As far as a CGMS: it has been shown that having a CGMS actually provokes people to test more frequently as they observe the upward and downward trends. A study about CGMS in different age groups was published in the New England Journal of Medicine and suggested its most optimal use in adults over the age of 25. Teens did not take advantage of the benefits and eventually took it off. The improvement in hb A1C was only statistically significant in the adult group. More studies will be conducted in school age children (but diabetes is most managed by parents in this group). In truth, as a parent, I can totally understand testing a bit more frequently for not only your child's safety, but for peace of mind. We can't help ourselves as it is embedded in our protective parental natures.

IMPORTANCE: 8

Extremely Bad and Unproductive Habits

1) Lying about blood sugar test numbers

2) Skipping meal boluses

3) Not testing before getting behind the wheel of a car (the four test minimum that Dr. Cogen talked about horrified me as being way too infrequent)

What are some of the worst "bad habits" Dr. Cogen has seen?

Dr. C's response:

1.  Lying about blood sugars. My patients know that this is one of the most upsetting behaviors that I face. I simply cannot manage their diabetes without truthful blood sugars. If they lie, I tell them that the behavior is unacceptable. Unfortunately, nearly every adolescent has tried once. After I discovered the fabricated blood sugars (and I always do), the visit becomes very unpleasant. They rarely repeat this behavior after I explain that I become a dangerous doctor without truthful information, and if I don't see real blood sugars, no driver's license. That about does it. IMPORTANCE: 10

2. Skipping meal boluses. It is an absolute disaster and wreaks havoc with blood sugar control. Missing boluses contributes to the incidence of diabulemia, diabetic ketoacidosis, and poor hb A1c's. This issue is in the top five of unproductive diabetes management schemes. IMPORTANCE: 10

3. Driving.To sum it up, No blood glucose testing? No learner's permit! IMPORTANCE: 100

Other significant dysfunctional diabetes behaviors:

4. Omission of insulin boluses/ and or injections to control weight can lead to eating disorders. An increasing number of teens and young adults manipulate insulin to maintain or lose weight. This process can lead to poorly controlled diabetes and frequent episodes of diabetic ketoacidosis.

5. Missing appointments, which prevent necessary interventions early on.