Sugar Surfing Lesson #7: Charting a course through time

Sailing across oceans has always been a potentially treacherous and risky endeavor. Before the days of engines, radio, radar, sonar and satellites, captains relied on a form of navigation called “dead reckoning”. Periodically, they would take sightings of the stars and constellations using devices like this sextant.

With careful tracking of prior readings, a reasonable course could be followed which would result in a safe arrival hopefully near their destination. Stormy weather, overly calm seas, ocean currents and constantly shifting wind patterns would require constant assessment and reassessment of the ship’s position, followed by decisions made about how best to re-direct the vessel towards its destination. It’s not surprising that the courses charted by many mariner’s zig-zagged and meandered even when a successful landing ultimately occurred. These are the courses charted by Christopher Columbus over 600 years ago.

There are many similarities between this old form of navigation and blood sugar management using a standard home blood glucose meter. When a sailor attempts to determine her/his relative position on the ocean using a sextant, there is a 'margin of error'. Blood glucose meters also possess a 'margin of error', as do glucose sensors. The weather and current conditions along a course are rarely favorable for charting a direct path. A circuitous course may be needed. And then as the environment is in constant flux, whatever course was charted in the morning might require a complete reversal later in the day. Captains and their navigators are good with this. It’s part of the challenge of the seas.

Those of us with diabetes never signed on to be boat captains. But in a way, we all must learn similar skills to chart a course to best manage our diabetes.

How often do you check your glycemic course each day? That might mean checking a blood sugar level using a meter. What do you do (or were you taught to do) with that single piece of information? Did it simply disappear into the memory chip in the meter once you turned it off? Did you jot it down into a log book? Did you immediately USE that information to determine if you were comfortable with the course you were on, or whether you needed to take some form of immediate action?

Frequent BG checks and self-care decisions made “in the moment” are still how many people with diabetes manage their condition. It works and can still work very well in the era of Sugar Surfing. Where it can fail is when the information is either not collected, not decided upon, or no is action taken when the information would call for it. Many people are not well trained in how to make those kinds of choices and choose the safer path of not doing anything. But not acting can allow your blood sugar to drift into treacherous seas.

In 2012, Kevin McMahon and I wrote about “frequent pattern management”, the philosophical foundation of Sugar Surfing™. Simply stated, FPM is looking at your own blood sugar data more often than every few weeks. Often, it means taking each sugar reading as an opportunity to choose an action and follow through on it. Inaction is a choice too.

The search for newer, faster, smaller, more accurate tools will never go away. But there are many underutilized tools in our diabetes arsenal which deserve discussion.

Time is a tool we can use. Master Sugar Surfers use time effectively. To best leverage time, it helps to possess the virtues of patience, consistency and resilience as I discuss in the book Sugar Surfing. What are these tools?

Frequency. We can glance at our CGM readout or check a blood sugar level more often (or sometimes less often). With each glance we build upon the previous one. In doing so, we create a more focused image of our course. This in turn allows us to make better choices about our next actions and how to follow up on their effectiveness. We can give insulin doses more often than just at meal time. After all, non-diabetic people release 11-12 pulses of insulin on an average day. Most of us dose far less often. Are we missing an opportunity?

Timing. Insulin takes time to work, even the faster ones. The same with meals and foods. Insulin and food also take time to fade away. They tend to peak in their action at some point in time after a dose is delivered. Time is an incredible self-care tool when its fully appreciated and applied properly. Insulin pumps can be turned into “insulin time machines” when judiciously used to deliver a bolus dose over a period of minutes to hours. Or a temporary basal rate can act to slowly steer a glycemic trend line away from low or high blood sugar waters.

Order. This is a derivation of time. The sequence in which actions are taken can heavily influence outcomes. For example, the order in which many meals are consumed with affect the change in blood sugar levels following completion of the meal. Sometimes, it’s is better to inject insulin after instead of before eating, depending on the glycemic trend and the type of food being consumed.

REMEMBER: Not all tools are tangible. And these tools cost you nothing but your time to master.

Sugar Surfing is a non-profit public educational charity. We depend on your donations to continue to share the message of dynamic diabetes management. Please make a small donation by going to www.sugarsurfing.com today and encourage others to support our mission to change the way type 1 diabetes is managed.