The Road to Less Than Optimal Blood Sugar Control is Paved with Good Intentions

For this post I pulled an oldie but goodie out of the archives. I wrote this more than 8 years ago and sadly it's still mostly true today. Even for people using CGM, information that should be easier to consider is kept beyond arms reach by the simple design decision of expecting people to login to a website to review reports. Better tools are coming but they take time.

From my own research, I know that 'pushing' that information to the person in need exponentially increases the likelihood that the information will be considered. For example, what if you received a notification on your phone about a pattern that has been identified? One click away from very useable information and you didn't have to do anything extra for the perk!

If you've been online lately you've heard a lot about IBM's Watson Health and their intent to apply some smarts to diabetes data for a similar purpose. I'm looking forward to seeing how they go about deciding on the hundreds of options to arrive at something elegant that works including personalization. What works for one person may not for another as well as the requirement to mix things up over time. Who wants to see the same thing over and over? Not me and certainly not my daughter.

Bottom line, a decade ago hundreds of people with type 1 and type 2 diabetes were already using Watson-like systems, mine included. It will take years for IBM and their partners to figure out the best ways to apply their data analysis and decision support to help people with diabetes. In the meantime, we have 'Sugar Surfing'.

Do you use mobile apps or sites with charts and graphs to help you understand your data? I'm not talking about real-time monitoring but actual analysis of the data after the fact. Does your analysis definitely make a difference in how you manage? If so, how? If you've figured out a trick or two I'm sure that others might find your approach interesting. Please also share how much time per week on average that you use the mobile app(s), website(s) or paper logs.

Managing your diabetes takes a lot of work. It can take less work however depending on which tools you use and how often you use them.

“Should I do shots or a pump?” Doesn’t matter if you are looking for ‘easier’. They both require a commitment although the tasks are different. Also, the typical person with diabetes doesn’t exist. Everyone is unique and therefore it requires the individual or at least someone with intimate 24×7 knowledge of the person with diabetes to have insight into care, actions, analysis of cause and effect, etc… No easy task even for the biggest egghead on the block. Unfortunately, there is no secret formula for one-size-fits-all blood sugar control either.

And don’t confuse collecting data with the act of analysis to understand and finally taking action followed up by further analysis to understand and take action in a never-ending cycle. This is called pattern management in the world of diabetes self-care.

So when it comes to looking at recent blood sugar numbers and potentially reams of other data like carbs, insulin and exercise to name a few, for patterns, very few people do it at all and even fewer do it right. There is more than one way to perform pattern management. And like everything else in life, you have hard ways and easier ways. If we look at the state of diabetes in this country alone, we quickly understand that nobody has solved the problem.

The average person using manual logbooks and PC-based or web upload software must spend 30 - 45 minutes given the complexity of these ‘free’ tools. So is it any wonder there is still a huge opportunity to improve on self-care? One way is to get more people to practice pattern management on a frequent basis. But how if it takes so much time and effort?

In a recent survey of both people with type 1 and type 2 diabetes, less than 10% of the respondents indicated that they performed review of blood sugars on their own. Most people will only review blood sugars during the office visit with their provider if they are lucky enough to even have a provider who practices pattern management.

In contrast, for participants in clinical trials incorporating our automated diabetes management system (ADMS), over 90% of participants are able and willing to practice self-review of blood glucose patterns weekly or more often week in - week out. What’s the difference?

Simplicity. It’s no extra work via ADMS so why wouldn’t you sneak a peak at your trends and consider where you’ve been, where you’re going and how you might take a different tack to affect a more desirable blood sugar result? The other key we’ve found out is that by doing this frequently, like every few days, most of the ‘other data’ behind the blood sugars is still in your mind. If you only look at patterns infrequently of course you would have to use a notebook with lots of other background data. Did I mention yet that nobody likes to keep a notebook?

Tracking insulin and carb data: why? Again, by performing frequent blood sugar reviews for trends, most of the background behind insulin, carb/fat, activity is top of mind. Ultimately, the patient is only going to address a trend at one time of day. Not all of the problems at the same time. As a real world example, one might spot a trend for high blood glucose at 10am and understand that this is cause to perform a 10% tightening of the insulin to carb ratio that got them to that 10am blood sugar trend. For example, that might mean adjusting the breakfast ratio. This scenario is made quick and painless for a person using an ADMS.

Frequent pattern management is key as it makes a simple version of the exercise possible by looking at only the system collected and formatted blood glucose data!

When I talk to patients through our work at clinics or while fielding calls with people in our trials and commercial programs, the most common concern I hear from people who aren’t already using a GlucoMON® is that they know they should be reviewing their logbook(s) for patterns more frequently. Lots of guilt in the diabetes patient community. When we talk about how they might increase their practice of pattern management, they are often stuck in the mindset of brute force… “I’m just going to have to force myself to do it more often”, they say.

Sadly, we all know too well that virtually nobody is going to brute force their way through this tedious task of assembling blood sugar data and markers to shed light on control. But what if patterns were an automated thing that just showed up in front of your eyes in a visually impactful way? Would that feel like cheating?

The point of this entry is to get more people to commit to regular and frequent pattern management. If you are performing weekly pattern management, is your current level of effort sustainable over the months, years and decades to come? If it’s too hard then consider that maybe you aren’t using the right tools for the job because others are doing it regularly and with success.

Originally posted on Diabetech's Challenge Diabetes Blog - February 19, 2008

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