Build an Effective Feedback Loop

By davidedelman Tuesday, April 14, 2009

This post is part of a series called Diabetes 2.0, a discussion about how technology is changing diabetes care.

 

Diabetes care has come a long way since the 1920s. Scientists have given the world fast acting insulins and medications to improve insulin sensitivity. They have built insulin pumps that can deliver highly accurate doses on demand. These advances, while important, are secondary to a more important development: the abundance of easy-to-obtain and accurate data about your blood glucose and the foods you consume.

 

Quality information lets you take control of your own diabetes care. You can set up feedback loops, systems that give you results you can use to continuously improve performance. Gathering and interpreting the data for these feedback loops is an area where modern technology shines - and it's only getting better.

 

Why Numbers Matter
Your blood glucose is influenced by a dizzying number of variables. Obvious influencers include the food you ingest and your levels of physical activity. Less obviously, there is sickness, stress, and hormonal changes. If you can identify how these factors interact, then you can maximize the precision of your treatment.

 

Accurate numbers let you run a series of experiments to untangle all of these variables. I ate two cookies and took two units of insulin. Did I go high or low? Next time, I'll take a little more or a little less until I find out the amount that works just right. I took 1000mg of Metformin and 50g of carbs at dinner and woke up with a fasting blood glucose above normal. Next time, I'll measure out less rice and see if I can improve my results. At first, all of this trial and error is hard work. But over time, you will get an innate sense of how everything works together and instinctively make small adjustments as you go along.

 

Create an Effective Feedback Loop
The foundation of a good feedback loop is quality numbers. In the past eighty years, we have moved from testing nothing to testing urine to testing blood. Now nearly-painless lancets make it easy to feed a tiny drop of blood into a machine and get the blood glucose level accurate within 10% in seconds. Continuous glucose monitors, in spite of some kinks, can provide up to 288 data points in a single day. From an historical perspective, collecting data is quite easy. It just takes a little discipline.

 

Now that you have all of this information, it's critically important to have systems in place to track it. You can use the old-fashioned workhorse, your brain, and a pencil and paper. Or, for the web savvy readers of this piece, there's electronic or web-based logging. Most meter companies provide tools for tracking and printing out reports of varying quality. The key is getting the information into a format that will let you spot trends.

 

Now it's time to use all of that data to make good decisions. On a regular basis, either weekly or monthly, print out a report of your numbers and look for trends. Are you consistently going high or low at a certain time of day? Is a predictable event, like working out or cleaning the house, causing an impact on your numbers? Share this information with your doctor to get guidance on how to adjust your treatment to improve your numbers.

Ann Bartlett, Health Guide
4/14/09 3:44pm

Hi David!

Great post! I understand that Juvenation, the JDRF site is set up to eventually include a video game component.  People will play a game and part of the score will be determined by their blood glucose level. 

 

As much as tehcnology has improved for diabetes, I would like to see more for treating and curing the complicatons.  There are researchers that have struggled to gain donors for reaching potential. 

 

It's a struggle for me to be overjoyed by technology when the real work needs to be blood and tissue.

4/14/09 4:07pm

Ann, I couldn't agree more. Unfortunately, as a non-scientist, I feel helpless in the blood and tissue area. But I can do a lot of good in my own way. I can help people find emotional support, track their own progress, and identify techniques for improvement. There are many who have reached the limits of success with traditional treatments, but that number is a small percentage. Most people could conceivably do a lot better if they had more information and better self-managament techniques. Technology has just begin to assist in the analysis and self-feedback areas. I will do what I can to push these areas forward while we wait for scientists to give more permanent and easier to implement improvements.

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By davidedelman— Last Modified: 10/26/11, First Published: 04/14/09