Significance: Sugar Surfing’s Secret Weapon

photo via public domain

In the world of dynamic diabetes management, blood sugar patterns are everywhere. Once you learn how to identify them; shelves, delta waves, inflections, lags and drops, are quickly seen after a quick glance at the blood sugar trend line. These shapes constitute a geometric language describing a person’s glycemic fingerprint in the moment. By the time my workshop ends, attendees understand this.

Any language system requires context to be meaningful. Sugar Surfing™ is no different. Significance is the context upon which Surfers understand the meaning of their glycemic trendline "in the moment". They will also work to create these shapes through their actions and non-actions (thoughtful omissions). This is also discussed online, in the book and at workshops.

To conceptualize how Surfers can evaluate the significance of a blood sugar trendline, consider the acronym C.A.R.E.:

Current actions (what are you doing now)

Anticipated (actions/omissions in the immediate future)

Recent (actions/omissions in the recent past)

Experience (your own under similar situations)

Taking C.A.R.E. is how a trained and practicing Surfer quickly assesses the significance of a trendline. Let me give a few examples.

• A fall in blood sugar of 30 mg/dl (or 2mmol/L) has two difference interpretations:

1. the drop is starting at 200 mg/dl (11.1 mmol/L)

2. compared to a starting point of 100 mg/dl (5.6 mmol/L).

In the second case a low blood sugar may be impending whereas in the former a high blood sugar is being effectively reduced.

• A rise in blood sugar of 30 mg/dl is considered differently

1. if it starts at 70 mg/dl (3.9 mmol/L)

2. compared to 180 mg/dl (10 mmol/L).

In the first case, this might represent treatment of a low blood sugar level and in the latter, it might mean too little insulin was taken for a meal.

A steady trendline (aka - 'shelf') traveling across a range between 70-100 mg/dl (3.9-5.6 mmol/L) might be less desirable to the mother of a newly diagnosed 3-year-old type 1 child compared to a 30-year-old type 1 expectant mother.

Glycemic “significance” is highly dependent on the situation and belongs exclusively to the individual. One hundred coins tossed into the air will never land in the same scatter ever again.

A “thinking” machine (like an 'artificial pancreas' or 'automated insulin delivery system') will struggle with interpreting the concept of significance for an individual. What is significant to one person may be irrelevant to another as highlighted by the examples above. As somewhat comical examples of current machine limitations, ask anyone familiar with Amazon's Alexa® intelligent assistant about spoken messages going to an unintended person's email or learning that Alexa is all too happy to unlock the front door no matter who is shouting the command, even from outside.

Sugar Surfing cannot be condensed into graphs, mathematical formulas, sliding scales, or algorithms. Wouldn't it be convenient if we could! Sugar Surfers must be trained. They cannot be manufactured on an assembly line.

My surf buddy Kevin McMahon and I began developing the concepts now known as Sugar Surfing starting way back in 2003 shortly after our first tech-enabled collaboration. We learned first hand about the possibilities and limitations of diabetes technology. With that background and the advent of continuous glucose monitoring, I coined the term Sugar Surfing and began publishing educational and encouraging posts here and there. The book was actually not our idea. It was requested by several hundred from the original surf colony. While the posts and books have been helpful, the most effective method of imparting these concepts to others has been to conduct live workshops. To date I've held several dozen around the US and overseas and continue on my mission to train as many willing learners as possible.

The fact that Sugar Surfing can't be "canned" or "packaged" is both its greatest strength and its greatest challenge.

A challenge only in that third parties can't easily mass produce Sugar Surfing manuals for the masses. As time moves forward I continue to refine what it means to Sugar Surf. Adopting new methods to educate and motivate potential Surfers is a passion and mission that Kevin and I share.

It's all about the training and practice which drive and define quality Sugar Surfers. Recognizing shapes and patterns is straightforward.

Understanding and acting on significance is the secret weapon that drives the Surfing process forward.