Monitoring blood glucose: Every reading gives an opportunity to learn

Diabetes health care givers should attach value to their patients’ blood glucose readings.

Issue: May 2006

ByVirginia Zamudio, RN, MSN, CDE

ByVirginia Zamudio Lange, RN, MSN, CDE

Virginia Zamudio, RN, MSN, CDE [photo]
Virginia Zamudio

A colleague of mine, a diabetes educator of many years’ experience, once shared a great analogy she uses when working with patients who are not yet convinced that monitoring blood glucose is all that important to their personal diabetes management. She asks the patient, “How comfortable would you be driving your car without any gauges on the dashboard? Would you be willing to drive around indefinitely with no gas gauge? How about having no speedometer, or engine indicators?”

Naturally, the patient agrees that safe driving requires these gauges. They concur that having real-time data on the condition of their automobile helps them to make rational decisions about their next action: If they’re going too fast, they respond by braking; if they’re running low on fuel, they stop at a gas station and fill up the tank. It’s a no-brainer for most drivers. If they are still resistant to monitoring their blood glucose, then she suggests they go out to the parking lot and pry the speedometer and gas gauge out of the dashboard, because this is how they are trying to manage their diabetes – without any gauge of their progress. This unconventional educator actually keeps a brightly painted crow-bar propped in a corner next to her desk to make the point!

Applying the same logic to the value of monitoring helps patients to begin viewing this self-care activity in a whole new light. They begin to see that their monitor will give them immediate and useful feedback: is their glucose higher or lower than their target? Armed with this information, they are in a better position to respond accordingly with adjustments in their eating and physical activity.

Not busy work

Too often, our patients get the impression from us, the health care professionals, that logging their blood glucose values is busy-work for our benefit. Clearly, the provider can, and should, use this gathered information to help make adjustments in treatment, especially medication management. But the day-to-day benefit of monitoring is of course primarily for the patient.

As a diabetes educator, I often hear patients remark that their physician advised them on a specific monitoring schedule. Because the patient trusts his or her provider, they often adhere closely to the advice, never straying from the testing schedule, even if it’s suboptimal or even if they never do anything with the numbers. Their logbooks are picture perfect, with dutiful logging of numbers and times, complete with the requisite smears of dried blood on the paper.

What’s often missing, however, is the patients’ ownership of the monitoring values as something useful and relevant to them. As health care professionals, we don’t always appreciate the magnitude of our influence on patients’ attitudes. Physicians’ strong and vocal emphasis that monitoring is ultimately for the patients’ benefit will go a long way toward elevating the importance of this activity of diabetes self-care. Of course, this shift must be coupled with the proper training in self-management. With education, the patient can learn to understand the connection between their behavior and their glucose values. Self-management education will help them learn to appropriately change their behavior based on the numbers.

Reinforce patients’ efforts

If the patient is willing to use monitoring as a tool in their diabetes self-management, the provider should review the logbook (or downloaded printout) with him or her at each office visit. Engaging the patient in a dialog about their blood glucose patterns and trends will reinforce the patients’ efforts at self-monitoring and help them to buy into any necessary lifestyle and treatment changes.

Another way health care professionals can help patients in their use of monitoring is to stress that there are no “bad” numbers, just numbers outside of their target range. By attaching a value of worth to blood sugar levels, the patient predictably transfers that value to their own worth as a “good” or “bad” diabetic. Physicians and diabetes educators should make a conscious effort to avoid this subtle trap. When the patient speaks this way about their numbers, we should verbally redirect their thinking by emphasizing that the monitoring is just a gauge that tells how his body is responding to his food choices, activity level, stress and medications (if applicable). Every blood sugar result should be treated as an opportunity to learn something.

Just starting out with monitoring, patients are often confused about which meter to buy. The newest meter with all the fancy bells and whistles may not always be the best choice. A meter that the patient can operate properly, one with features that match his lifestyle and personal needs is the best fit.

A diabetes educator can be very instrumental by helping the patient to figure it all out. This determination will include an assessment of the patient’s manual dexterity (is he able to handle the test strips?), visual acuity (is the digital printout too small to read?), cognitive ability (are there too many steps involved for the patient to remember?), as well as investigating the insurance plan’s coverage requirements (is this meter on the plan’s preferred list with the lowest copay?).

This assessment should be made prior to writing a prescription for the meter to avoid frustration and wasted time and money. Having the right meter from the start will help create a more positive outlook about monitoring.

The take-home message is: Patients are more willing to follow through on treatment recommendations regarding monitoring when they understand the “why” behind it, and then only if it is relevant to their everyday experience. Health care providers are influential in how patients think about their diabetes self-management, and physicians and diabetes educators should team up to help patients maximize their monitoring self-care behavior.

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Virginia Zamudio, RN, MSN, CDE, is a partner at the Alamo Diabetes Team LLP, an entrapreneurial diabetes self-management training center, and is a past president of the American Association of Diabetes Educators. She is co-medical editor of Diabetes Vital, and is a member of Endocrine Today’s Editorial Board.