Logging Off

Almost everyone has an unread book or two in their home. For many, they continue to purchase new books at a pace that far exceeds their time available to read them. For some, this buying compunction comes out of a sense of guilt with their conscience whispering, "You know you really should read more".

The problem is that simply buying a book is not the same as reading it. And just because you bought the book, or borrowed it, won't relieve you from the guilt of not actually reading more. So why do we do it... this habit of continually stocking more books than we can read?

Here's a theory. Taking action toward satisfying a core belief, "People should read more books", is better than taking no action at all. "What has this got to do with diabetes?", you ask? For starters, we know that most of the people who have purchased Sugar Surfing haven't yet read the book. That's perfectly understandable given the daily demands of managing blood sugar amidst an already busy life. The good news though is that it's there on the shelf or the counter and some day you may pick it up and open to a random page. Quite possibly, the words on that page will be precisely what you needed to read that day. In addition, just the act of purchasing the 'hot new diabetes book' probably made you feel good about 'doing all I can do' to manage this beast. A well intentioned act for sure and one that definitely sets you apart from the crowd. A truly proactive #pwd. But then there's the guilt of not reading it or not following through with the suggested track of self-experimentation. It's a lot like blood sugar logging.

And here is the point of this post. Why do we log? Almost immediately following diagnosis we are taught how to log data about our diabetes. We are given a meter, a special paper form, a spreadsheet template or perhaps told to use a certain mobile app. If we want our medical team to be in a position to help then we all have to be on the same page, right? At first, many are diligent at complying with the task of logging. We share our logbook when we need help and in return we get advice that we may or may not find helpful. Before long our detailed logs become less about sharing and more about doing what we were told. We learn to self manage. We make our own changes without oversight. For most, we find that logs are more effort than they are worth. So we stop. For others, the guilt of completely discontinuing the logbook is too much. Plus, we don't dare show up for our next quarterly appointment without it. Oh, the guilt.

If you like keeping a detailed logbook and it works for you, great. Keep it up.

However, if you find that it isn't useful then why continue? Several years ago, we observed in a study of an automated blood sugar logging and reporting tool (just blood sugar - nothing else) what a difference frequent review of blood sugar logs make with regard to blood sugar control. For people who only used a meter and not cgm, the average bg checks per day was about 4.5 for children under age 12. We discovered that families who reviewed those data at least once per week had clinically significant improvements vs their peers in A1c and emotional measures. And what was key to this study was that the medical team was not involved. It was purely a self-care driven result. We also saw an increase in the frequency of blood sugar checks over the course of the year. And to the point of this post, none of these patients kept a logbook beyond what was automatically reported from their meter.

Here we are several years later and more and more people are using cgm. We as a community of patients and medical providers are beginning to understand that there are differences in how to manage diabetes depending on which tools we use (ie cgm vs bgm with a meter). That's essentially how we arrived at Sugar Surfing albeit this method has never been scientifically studied. Rather, we developed it out of real world observations by thoughtfully decomposing a set of actions that seemed to be a better fit for a frequently informed patient.

The person using a cgm typically looks at their blood sugar dashboard 20 to 30 times per day. As a surfer, you may easily find yourself glancing up to 40 times or maybe more. And yes there are many people who are checking their cgm 4.5 times per day who perhaps haven't figured out the value of cgm vs bgm.

For people who frequently work remotely with someone else to make changes, a logbook is probably a very useful tool at least some of the time. For trouble spots of a few hours or a couple of days, we concede that there may be value in keeping a logbook.

However, for someone who has fully embraced their cgm and employs Sugar Surfing, please understand that we too don't see the need to keep a logbook.

After all, Sugar Surfing is built on the fact that there are so many variables influencing blood sugar that simply capturing three or four hardly represents a complete picture for historical review. In fact, this focus on limited data can set up a remote caregiver or medical provider to take actions based on assumptions. Just imagine if you told a room of 100 people to write a children't story book that has to include three elements: a little girl, a wolf and a grandma. How many different stories could they write? Of course, I would assume that it would read like 'Little Red Riding Hood' but someone else who never heard of that story could easily write about a life-long friendship between the girl and the wolf. You get my point.

Sugar Surfing is largely about steering your blood sugar levels "in the moment". It's more about looking at the trending of sugar levels within the context of what you are doing at a given moment of time. It's situationally dependent. Because of its forward looking and 'in the moment' approach, Sugar Surfing replaces the old fashioned method of logging blood sugar readings in a book or spreadsheet as a means of control. Information collected in log books is intended to serve as a predictor of future outcomes. Most of us with diabetes experience know that at best we might be able to predict only 50% of what happens based on careful and meticulous BG logging. Log books are historical documents. They are helpful for identifying patterns or responses to actions or omissions previously taken. They are like the post game films coaches show players on Monday morning. Helpful for identifying problems and areas for improvement but not always predictive of what will happen in the next game. But for managing diabetes dynamically (Sugar Surfing), relying only on data from retrospective BG log books is a lot like trying to drive a car by only looking in the rear view mirror. The annotated images in the book Sugar Surfing along with those posted on the website and shown at live workshops are intended to illustrate the thought process involved when 'in the moment' decisions are made along a BG timeline/trendline. So for persons new to Sugar Surfing, put down your logbooks and pencils and focus on riding or steering the glucose wave. Looking back is helpful for reflecting on the immediate outcomes of choices made. And periodic review of old data might be helpful if you can recall all the details which went in to a specific BG response pattern. Acquiring a new physical skill typically requires practice and lots of repetition. I had to hit tens of thousands of tennis balls to achieve the ability to hit a topspin serve. Every athlete knows this. Imagine what my tennis logbook would have had to look like to be useful. Too much work and not enough data versus the tried and true focus on experience as the teacher. Sugar Surfing isn't about just keeping a log book. It's much more than that. The annotated images will take you only so far and I only do that to help others to understand how I make my decisions. I'm not expecting you to do that although it might be helpful from time to time to deconstruct your actions. Sugar Surfing requires a holistic approach and those data are only available in the mind of the actor.

For all of those unread books on the shelf, stop feeling guilty that you haven't yet gotten through them yet. For people who purchased Sugar Surfing and have not yet read it or you're not satisfied with your diabetes management, read the book in its entirety or attend a live workshop to get the big picture. And for goodness sake, stop feeling guilty about the logbook.

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