USE YOUR BLOOD GLUCOSE METER TO HELP YOU IMPROVE YOUR HEALTH

USE YOUR BLOOD GLUCOSE METER TO HELP YOU IMPROVE YOUR HEALTH

BY ASHLEE ERNST AND BETSY OTTEN

This article was published by diaTribe and has been licensed for reproduction by Children’s Diabetes Foundation for NewsNotes.

Betsy Otten and Ashlee Ernst

While many people with diabetes use a blood glucose meter to check our blood sugar levels, you may not be using your meter often enough to help you feel better. Ashlee Ernst and Betsy Otten, two diabetes nurse educators, share tips on how to get the most out of your glucose checks, how to read data reports, and how to find a meter that’s right for you.

As diabetes nurse educators at the Barbara Davis Center for Diabetes at the University of Colorado – one of the largest type 1 diabetes clinics in the world – we see A LOT of blood glucose data. And as people who personally live with diabetes, we also understand how tedious it is to perform blood glucose checks. In this article we talk about ways to maximize your blood glucose testing, both in recommended frequency and in how to understand your data.

There are two big reasons why blood glucose checks are important. The first is the most obvious: you do it to make sure your glucose levels are safe throughout the day and over time. The second reason is the focus of this article: analyzing patterns in your glucose levels can help you and your diabetes care team make insulin dose adjustments and figure out ways to increase time spent in a healthy glucose range (70-180 mg/dl), often referred to as Time in Range, or TIR. While you may only work with your care team at visits every three to six months, you can learn to use blood glucose data on your own to make daily habit changes and insulin dosing changes. The key is learning how to maximize the data that you get from your blood glucose meter.

ABOUT ASHLEE AND BETSY

Ashlee Ernst is a registered nurse and diabetes educator at the Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO. Ashlee was diagnosed with type 1 diabetes at the age of nine in Lincoln, Nebraska. From a young age she saw the impact that the diabetes community had on her life and knew that she wanted to integrate her future career into this community. Now 16 years later, she is working in the Pediatric Clinic at the Barbara Davis Center, supporting patients and families throughout their journeys with diabetes. Ashlee enjoys giving back to the community through planning and volunteering at camps for children with type 1 diabetes.

Betsy Otten is a registered nurse and certified diabetes educator at the Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO. Betsy has lived with type 1 diabetes since 1997. After many years attending and volunteering at diabetes camp with many awesome diabetes educators, Betsy decided to become a nurse and pursue a career in diabetes education. Betsy works in the Barbara Davis Center Pediatric Clinic educating people who are newly diagnosed and their care-partners, as well as people living with diabetes during routine clinic visits. She enjoys leading projects and opportunities to improve clinical care and life for children and adolescents living with type 1 diabetes.

First, it is important to have at least one week of data (and more is better!) for you and your care team to review at appointments. The best way to evaluate diabetes management is to review blood sugar and activity data and then to identify patterns. For blood glucose data, people are often told to check four times a day – but is that enough?

If we only check blood glucose levels before meals, we miss the opportunity to look for variability throughout the day. The more data we have to work with, the better. As diabetes educators, we recommend checking six to ten times a day, including before meals, snacks, physical activity, and bedtime, along with the occasional postprandial checks (in the three hours after a meal) and overnight checks. If for whatever reason it is not realistic to check your blood sugar this frequently, it can still be very helpful to do this for one week at a time every month or two. These “data collection” weeks can provide invaluable data for insulin dosing and for assessing habits, and they can provide insight on your ongoing diabetes management.

ADDING CONTEXT TO YOUR BLOOD GLUCOSE CHECKS

In addition to blood glucose checks, meters also have the ability to log other key variables that can affect your blood glucose levels. This includes information such as carbohydrate intake, insulin doses, exercise, and even other variables like menstrual cycles. This information paired with your blood glucose levels provides a fuller picture of daily life with diabetes. Consistency is key when logging data. This is why we recommend trying to include as much information as you can for a week at a time. The logging process can feel tedious, but the payoff is worth the effort.

When you have at least six blood glucose checks available each day, you and your diabetes team can analyze key glucose metrics that are typically only available to people with continuous glucose monitors (CGM). These metrics include Time in Range (TIR, 70-180 mg/dl), and time spent below range (less than 70 mg/dl) or above range (greater than 180 mg/dl). With TIR you do not have to wait for a quarterly or bi-annual A1C to understand how your diabetes management is going – you can calculate these direct measures of glucose management for any time period you wish, though we recommend reviewing at least two weeks of data at a time. TIR empowers you to set clear goals for improvement: a goal of increasing time spent in range from one week to the next is more manageable than a goal of dropping your A1C by some percent in the next three to six months. By setting smaller goals, you create a path of stepping stones that will help achieve your big goals.

UNDERSTANDING YOUR DATA REPORTS

How should you look at data on your glucose reports? We recommend starting with one piece at a time. Download your report and then begin by highlighting areas where you see patterns of hyperglycemia (high glucose, greater than 180 mg/dl) and hypoglycemia (low glucose, less than 70 mg/dl) – this will allow you and your care team to identify where adjustments need to be made.

When we review a person’s glucose information, we begin with hypoglycemia and assess the percentage of time spent below 70 mg/dl. Our goal is for people to spend less than 4% of their day (or less than one hour) in this low range. The next area we focus on is TIR, with a goal of spending over 70% of the day (almost 17 hours) with glucose levels between 70-180 mg/dl. This will directly correlate with an A1C of 7% or less. Many data reports also give you an estimated A1C, based on the average blood glucose during a period of time.

Often you will see standard deviation next to the average blood glucose. The standard deviation can be best explained as how far the blood glucose “swings” either high or low. If your standard deviation is large, then you may experience lots of variability in your blood glucose. By making your glucose levels more consistent throughout the day, you’ll reduce this number and, typically, you’ll feel better. Some fluctuation in blood glucose is expected, though; to calculate your target standard deviation, take your average blood glucose and multiply it by 0.33. Once you’ve calculated your target, compare this number to the standard deviation on your report to see how close you are.

All said, don’t get overwhelmed. Many times, focusing on one area of your diabetes management will have a positive effect on other areas, and small adjustments can have big impacts.

DIABETES NEWS

DIABETES NEWS

The moral of the story is that it’s important to collect – and track – as much blood glucose data as possible. While there is no “perfect” glucose meter for everyone, there are meters that make data logging easier, and others that have easy-to-read data reports. The table on page 6 shows our personal assessments and key details of blood glucose meters that have a Bluetooth-connected app and data reports, to guide you in choosing how to access and review your data.

Bluetooth-connected meters and smartphone apps are not for everyone. The list below includes other options for logging, in order of what we consider the easiest to the most labor-intensive way to access and interpret data (not considering initial set up).

• Meter + data upload to a computer o Most meters + Tidepool software o FreeStyle meters + FreeStyle Auto-Assist software or LibreView • Meter + manual entry into an app o mySugr o Sugarmate o OneDrop • Meter + manual entry into an Excel Spreadsheet, with functions to calculate averages, standard deviation, etc.

You’ll have to develop this spreadsheet on your own.

However you choose to review your data, we hope that these tips help you understand what data is important, how to access that data, and how to translate the data into meaningful changes in your daily diabetes management.

Accu-Chek Guide, Guide Me + AccuChek Connect App (US)

Medium App quickly displays 7-day TIR summary

Able to email or text reports from the app Low Report generated directly from app lacks visual tools such as graphs and color coding as well as logbook view of data

(Logbook Report from Accu-Chek Connect Online included clear summary and logbook, but was not easy to access)

Accu-Chek Guide, Guide Me + mySugr

Contour Next One + Contour Diabetes App

One Drop + One Drop: Transform Your Life App

OneTouch Verio Flex, Reflect, Sync + OneTouch Reveal App

True Metrix Air + True Manager Air App

High Clearly displays estimated A1C & summary of current day including: average blood glucose, standard deviation, number of hyper/hypo events, carbs, bolus events, and activity

Visuals are clear, pleasant, and intuitive

Highly customizable tags to track events High Visually appealing and concise with the use of color coding and a clear layout of information

Includes summaries of overall, weekly, and daily data

Medium Can easily access TIR on the app home screen

Shows 14, 30, and 90-day averages

Some app visuals not optimized for specific phones/operating systems Medium Weekly summary with key information included at top of the report

Daily summary included in logbook view

Readings less than 2 hours apart overlap, making days with multiple checks more difficult to interpret

High Allows you to easily view your average glucose, total carbs, exercise, and insulin doses for the day

Provides you the opportunity to log other medications besides insulin High Daily log maximizes analysis of patterns via color coding and including carbs, insulin, blood glucose, and exercise together

Daily and weekly summary data included in logbook report

High Easy to enter daily events

Can send reports directly from the app via email

App provides summary data and analysis of patterns High Provides easy access to total daily dose of insulin, average blood glucose, and TIR

Medium Clear display of average blood glucose and TIR

Very simple graphics

Some weird app visuals probably not optimized for specific phones/operating systems Low Provides a daily list layout that may be appealing to users

No logbook view of data

Summary data useful

Graphs are not easy to interpret or utilize in meaningful ways when making dose adjustments