USUAL DOSES OF INSULIN OR ORAL AGENT. If you require insulin or an insulin-sensitizing or insulin-mimetic agent* to maintain your target range, you will have to follow a precise regimen. It will therefore be important to have your blood sugar medications spelled out so that even if you forget, you can always refer to the doses and times in this field. When you are to take a medication before a meal, cross out “post” (as shown below); when you are to take one after a meal, cross out “pre.”
If your physician asks you to change the dose of one of your blood sugar–lowering medications, put a line through the prior dosage and enter the new dose to the right of the old one, as in the following example:
In this fictitious example, the patient had been injecting 2 units of Levemir insulin on arising when this data sheet was started. In addition to insulin, he had been taking three 500 mg tablets of Glucophage (an insulin-sensitizing agent) 90 minutes before dinner. During the week the sheet covers, his dose of insulin on arising was reduced to 1½ units and his dose of Glucophage before dinner was reduced to two 500 mg tablets. Retaining the old doses in this field can give your physician an important at-a-glance history of the changes that were made.
1 UNIT____WILL LOWER BLOOD SUGAR [insert the abbreviation of your more-rapid-acting insulin]. This field is for use only by people who take insulin and use rapid-acting insulin to bring down elevated blood sugars. In Chapter 19, “Intensive Insulin Regimens,” we’ll discuss guidelines for calibrating the effect that 1 unit of rapid-acting insulin will have upon your blood sugar. Meanwhile, enter on the form the amount of blood sugar reduction (mg/dl) that your physician suggests will be achieved by injecting 1 unit.
MISCELLANEOUS. This field (box) is for any other pertinent guidelines or instructions that you may have difficulty recalling. Some people enter the times they should check their blood sugars. Thus, depending on your regimen, you might write:
BG -on arising
-before meals
-2 hr post meals
-bedtime
-when hungry
If this field is too small for all you wish to enter, use the top margin of the form.
BG EFFECTS OF SWEETS. If you use insulin or oral agents, you will be taught how to use glucose tablets or liquid to raise your blood sugar rapidly. In Chapter 20, “How to Prevent and Correct Low Blood Sugars,” we’ll discuss how you will calibrate the effect that 1 tablet has on your blood sugar. Thus, if 1 Dex4 raises your blood sugar 18 mg/dl, you would write:
1 D4 → ↑18
Alternatively, if your brand of glucose tablet is Wacky Wafers (which might raise your blood sugar 10 mg/dl), you could write:
1 WW → ↑10
You will also learn to calibrate the effect 1 gram of carbohydrate has on your blood sugar. If 1 gram will raise your blood sugar 5 mg/dl, you would write:
1 gm CHO → ↑5
EXERCISE ADJUSTMENTS. This field is also used only if you use insulin or oral agents. It reminds you what to eat for various forms of exercise to prevent your blood sugar from dropping too low. Thus, if you were planning to spend the afternoon at a shopping mall (which can be treacherous, because this often requires considerably more walking than we realize), you may be advised to eat half a slice of bread at the start of every hour to keep your blood sugar from falling too low. Thus, you might write:
Mall—½ brd/hr
ABBREVIATE NAMES OF ACTIVITIES AND MEDICATIONS. Space constraints make it necessary to use abbreviations. Use the first one to three letters of the name of each activity or medication. Using these abbreviations will help both you and your physician to know immediately the details of “events” that affect your blood sugar.
As you can see, each day is broken up horizontally into three columns—TIME; BLOOD SUGAR; and MEDICATION, EXERCISE, FOOD, ETC. Vertically, each column is broken up into 3-hour blocks, except the 9 PM THRU 1 AM and 1 AM THRU 6 AM blocks, which are 4-hour and 5-hour blocks, respectively. During each day, you will experience various “events” involving your blood sugar. An event may be a meal, a dose of medication, exercise, or even a blood sugar measurement itself. These should be recorded in the corresponding column and time block. You should not record a dose of medication that does not affect your blood sugar levels, such as blood pressure medication.
TIME. In this column, write the exact time of the event. If you measured your blood sugar at 1:30 P.M. on Tuesday, write 1:30 in the 12 NOON THRU 3 PM block of the time column for Tuesday.
BLOOD SUGAR. In this column, write all blood sugar readings. If for some reason you do not have your blood sugar meter with you (a minor crime) and you experience symptoms suggestive of low blood sugar, write “Low?” in this column in the appropriate time block and proceed with the instructions for correcting low blood sugar in Chapter 20.
MEDICATION, EXERCISE, FOOD, ETC. This column is a catchall where you should record all events other than blood sugar readings. Following are a few examples of events and how you would record them in abbreviated form in the proper blocks:
| Injected 5 units of Levemir insulin | 5 Lev |
| Ate breakfast | B |
| Consumed more food at dinner than prescribed | ↑DIN |
| Took ½ Dex4 (glucose tablet) | ½ D4 |
| Took two 500 mg Glucophage (metformin) pills | 2 × 500 GP |
| Walked 2 miles | Walk 2 mi |
| Went shopping for 3 hours | Shop 3 hr |
| Injected 1½ units Humalog insulin, intramuscularly (into a muscle) | 1½ H—IM |
| Sore throat all day | Sore throat [enter at the top of the day’s column] |
| Went to dentist | Dentist |
Once your blood sugars have been fine-tuned on one of the regimens described in this book, we expect that they will remain within narrow limits of your target value most of the time. There will, in all likelihood, be instances when your blood sugars will deviate from your target range.
Sometimes you may stick precisely to your diet and medication plan but then find yourself in a restaurant and simply incapable of letting the dessert cart go by without partaking of its wonders. Your blood sugars will naturally show a precipitous rise. Or you may get some exercise that makes your blood sugar go too low. To make it easy for both you and your physician to understand and evaluate such connections, circle the cause, then circle the resulting blood sugar value, and connect the two circles with a line. For example, a high morning blood sugar might be circled and connected to “snack” at bedtime the previous night.
Even though you stick to your regimen with an iron will, your data will sometimes show an unexpectedly high or low blood sugar value. Repeat the measurement after washing your hands (to remove any traces of food or glucose) and ensure that you haven’t inadvertently slipped on your measurement technique. If the unexpected reading persists, circle this value, as it may require further investigation. There are several strange biologic phenomena that can affect your blood sugar, and these are detailed in the next chapter. Your physician or diabetes educator should help you figure out the cause of unexpected blood sugar readings so that you can prevent or anticipate them in the future.
Now that you have been exposed to blood sugar self-monitoring and the recording of data, you can begin using this knowledge to normalize your blood sugars.
I will personally answer questions from readers for one hour every month. This free service is available by visiting www.askdrbernstein.net.