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.