Your blood sugar levels are affected by a variety of things: what medications you are taking (such as insulin or oral hypoglycemic or insulin-sensitizing agents), what exercise you may have performed, whether you’ve got an infection or cold, what you ate, when you ate it, and others you will discover as you track your blood sugars. Many people find, for example, that such things as competitive exercise, public speaking, or arguments can raise blood sugars. All of these bits of information—not just your blood sugar levels—need to be recorded and taken into account. Without this detailed information—your own personal blood sugar profile—your physician or diabetes educator cannot assist you in developing an ongoing program for blood sugar normalization. To my knowledge, none of the many forms or computer programs currently available for this purpose show adequate information in a readily usable format. The GLUCOGRAF III data sheet,* like our program, was designed by a diabetic engineer (me) for diabetics.
GLUCOGRAF III data sheets are printed identically on both sides so that each page provides space for two weeks’ worth of data. If your physician wants detailed information about the content of each of your meals, use one side to list meal content and the reverse to list medication, blood sugars, exercise, the times of your meals, and so on. The data sheet is designed so that you can fold it up and carry it with you. I recommend carrying a fine-point pen (0.1 mm) with you as well. It will help when space is tight—which is likely, particularly in the MEDICATION, EXERCISE, FOOD, ETC. column, where much information must be written in a small space. If you will be faxing, scanning, or e-mailing your sheets to your physician, do not use pencil, as it doesn’t always copy or transmit clearly.
The rest of this chapter is divided into sections corresponding to column and field headings on the GLUCOGRAF III form, and explains the sorts of things you ought to be recording and the most informative ways for doing so.
Across the top of the data sheet, there are several fields with space for entering important information.
NAME. Entering your name will ensure that the form will end up in your chart at your doctor’s office and not in someone else’s.
DOCTOR’S PHONE. This field should contain the telephone number at which you can reach your physician when you are asked to discuss your blood sugar and other data.
DOCTOR’S FAX/E-MAIL. If you will be faxing your data sheets, enter your physician’s fax number as well. Alternatively, if you would usually scan and e-mail your form, you might enter his e-mail address here—or just put it in your “address book.”
TARGET BG. This is the blood sugar goal that your physician will assign and that you will try to maintain. Although normal is approximately 80–85 mg/dl, in certain instances your physician may opt for a higher value for a brief period. If you’ve endured very high blood sugar levels for an extended period of time, your physician will not instantly try to normalize your blood sugars, as you may at first feel uncomfortable (hypoglycemic) at a normal value. If you take insulin, he’ll assign a series of intermediate target values, together with instructions for correcting blood sugars to reach these levels as you work toward blood sugar normalization. If your initial blood sugars show that you are in the 300–400 mg/dl range, he might set a target of, say, 175 mg/dl for a brief time. If you have gastroparesis (delayed stomach-emptying; see Chapter 22) and use insulin, you are at real risk for severe hypoglycemia. Your physician may therefore recommend a target well above normal for an indefinite period of time, to provide a safety factor that reduces the likelihood of very low blood sugars.