checking-glucoseMonitoring blood glucose levels provides important information to help people with diabetes make management decisions. There are many opinions about monitoring--who should and shouldn't monitor--but if it helps someone manage their disease, then it can be a very valuable part of self-care. Home blood glucose monitoring (HBGM) is empowering in the hands of the person who wants to take and keep control of their diabetes, and who feels like HBGM will help them stay on track.  

If you want to use HBGM to help you make decision about your diabetes, then learning how to interpret the numbers is the first step in effective troubleshooting. The American Diabetes Association (ADA) has established the following blood glucose targets: fasting and before meals 80-130 mg/dl, 2-hours after meals <180 mg/dl and bedtime 110-150 mg/dl. You and your healthcare provider may individualize the targets some to meet your individualized needs, but if you are not sure the ADA targets are safe guidelines. How to properly interpret the numbers that are not in the target range is always the challenge. 

It can sometimes be like putting a jigsaw puzzle together or detective work to make sense of it all and come up with a plan.  Here are some tips to help you understand and troubleshoot the highs and lows.

It’s important to look for blood glucose patterns, when you are going to use HBGM glucose monitoring to help you improve your diabetes control. The idea is not to make drastic changes in your routine after one low or high reading. (Always treat low blood glucose readings with the rule of 15). It’s when you identify a pattern of low or high blood glucose at specific times that you want to problem-solve and take action. We call this pattern management.

There are three questions that you want to answer: What is the pattern? What is causing the pattern? What can I do about the pattern?  

Let’s discuss fasting blood glucose values first. We have this saying in diabetes education to fix the fastings first. Also, you always want to address any patterns of low blood glucose because low blood glucose is very dangerous.  So, let’s say the person with diabetes identifies a pattern of low fasting blood glucose levels. There are three variables to consider as possible causes: food, activity, and medications.  

Important food and beverage questions are: Is the person skipping dinner or avoiding carbohydrates and not eating enough carbohydrate? What time is the last meal or snack? if there is a snack? Is alcohol being consumed?

If food or alcohol may be the cause here are possible solutions: include a bedtime snack of protein and a serving of carbohydrate; eat dinner a little later and reassess carbohydrate content at that meal, perhaps it’s not enough; if drinking alcohol, the guideline is no more than 1 drink for women and 2 for men, and be sure to have a snack if drinking.

When considering activity, question how your evening activity increased. Maybe you had not noticed any significant blood glucose changes from that evening walk initially, but now that you have increased walking time and intensity it’s having an impact on your blood glucose.  In the spring and summer many people notice that with gardening and evening yard work that they begin having lower blood glucose readings in the mornings. Is that evening project burning more energy than you realized. Remember we are looking at patterns, not just one number. Usually, it’s great when you increase your activity, so if this is determined to be the cause, I wouldn’t recommend decreasing activity but perhaps adjusting food or talking to your provider about our next variable–medications and insulin.

In the case of a low fasting blood glucose pattern, when examining medications/insulin we would question if the person is taking too much. Perhaps it use to be the correct amount, but you have lost weight and are more active so talk to your healthcare provider about possibly decreasing your doses or eventually stopping medications/insulin, if warranted. You may realize the controlled carbohydrate diet was once a challenge, but now you are consistently eating the right amount and making better food choices, so medication may be reduced.

Let’s say your pattern is opposite, and you have found a pattern on high fasting blood glucose. What’s causing the pattern? And what can you do about it?

Possible causes: late dinners, large dinners, snacking, increased sedentary time, not enough medication or insulin, forgotten medication or insulin. Also, in the case of high blood glucose we need to consider the impact of chronic stress and/or pain on HBGM.

Here are possible solutions for the above causes: decrease portion size, brush-up on your carbohydrate counting skills, eat earlier, decrease snacking or have one healthy snack in the evening instead of multiple snacks, engage in some activity.  If the lifestyle factors are not the cause, then you should talk to your healthcare provider and review your medications/insulin. If pain or stresses are part of the cause, talks to someone about this, there are resources and professionals to help you manage and cope in these areas.

Another common blood glucose pattern that people identify is elevated after meal (post- prandial) blood glucose readings.  What’s causing the pattern? And what can you do about it? Likely causes for this pattern are too much food, the wrong foods, and/or not enough medication or insulin.   

Solutions: decrease portion sizes; learn which foods are better choices to reduce the blood glucose spike after the meal.  If you have been on the same diabetes medications for years, maybe it’s time to consider one of the newer medications; or do you need a medication dose change.  Review your insulin regiment with your doctor, can it be fine-tuned to improve your control.   

Questions and more questions, right. Sorry, I can’t give you the answers for your personal patterns, but I can give you these questions to ask and answer. Make an appointment with a diabetes educator or your doctor to discuss your patterns and do some problem-solving together. Get support and empower yourself with the proper knowledge to troubleshoot the highs and lows.