When your doctor diagnosed you as having diabetes, did he issue you your detective badge right then, on the spot?
In case you are new at this and don't know what I am talking about, let me explain. This is certainly something you will need to know about.
Have you ever watched any of the police or crime shows on TV? It seems to me that they all begin about the same.
A cell phone rings, a shirtless man or scantily-clad woman awakens from sleep and reaches over to the bedside table, switches on the lamp, and picks up the phone. All you hear is a one-sided conversation.
"Sanders... (pause)... When?... (another pause)... Any witnesses?... Be there in 20 minutes."
The next scene: The sound of an approaching siren, lights flashing and an unmarked car screeching to a halt. A crowd is standing around something, usually a dead person. You see Sanders walk up, now in some sort of a long coat, holding a steaming cup of coffee.
A uniformed officer comes up. Sanders speaks.
"Hey Johnson, what do we got?"
The uniformed cop reads notes off his note pad. "White male, approximately 30 to 40 years old, found dead, laying face down in the street about 1:15 a.m. this morning, by this lady, Joan Doe, while she was out walking her doberman."
"Anything else?" Sanders asks.
"Well, some witnesses say the dog was walking her," Johnson states.
Sanders turns his attention to the small woman, "How did you know the man was dead?"
"There was a chalk line around his body," she replies.
So you ask, what does any of this have to do with diabetes?
Does any of this sound familiar? I believe just about every police show starts off with a murder being committed.
Then what? A detective appears on the scene, asks a lot of questions and looks for clues that would help the detective solve the crime. Just before the end of the show, the detective has enough information to solve the murder. So, what does this have to do with you and your diabetes?
Every time you test your blood sugar and it's not what it's "supposed to be," either too high or too low, then a crime has been committed. What's the crime? A blood sugar that's out of range.
When you get a reading that is too high or too low, you should figuratively, pin your detective badge on and begin looking for clues as to what caused it.
Let's say you test your blood sugar two hours after breakfast. Your reading is 227mg/dl. Not so good. You turn your work ID around to its back side, the side that's got the picture of the detectives badge glued to it. That's right, for the next several minutes you are not Jim the software engineer, you are Detective Jim. Let's get started.
"So Jim, why is your blood sugar level so high two hours after breakfast? What could have caused it?"
"I don't really know," you say.
"Is it possible you ate too much for breakfast?" Jim asks.
"No, I counted my carbs, only had about 50 grams, 60 at the most, which is on my meal plan."
"Tell me," continues Detective Jim, "did you happen to check your blood sugar before breakfast, and if so what was it?"
"It was 180mg/dl." you answer.
"So, your blood sugar was high before you ate?" Jim acknowledges.
"Yes sir," you respond.
""So if it was high before breakfast, it's likely that it would be high after breakfast, even if you ate the right food." Jim comments.
"So, now we know why you were high after breakfast, because you were already high before breakfast. Now the direction of the investigation needs to turn to look at why the blood sugar level was elevated before breakfast."
"Let's go back about two hours from when you woke up. What were you doing?"
"Did you eat anything in the middle of the night?" Jim asks.
"No," you reply.
"No, I never eat anything in the middle of the night unless my blood sugar goes down too low," you tell Jim.
"Okay, is it possible you forgot to take your diabetes medication last night?"
"I took one of my diabetes medications but not the other one because I ran out."
"What is the name of the medication you did not take and how much are you supposed to take?"
"Metformin, and I take 1000mg with dinner."
"We may have just solved the crime! Missing that evening dose of medication may be the cause of your high blood sugar before breakfast.
Just to be thorough, let me ask just a few more questions. Did you have a snack just before you went to bed?"
"No, not last night."
"Did you eat later than usual, or did you eat more than usual?"
"Well, both, I ate about two hours later than I usually do, and I ate more than I usually eat.
"I'm going to close your case now. My report will indicate that your elevated blood sugar after breakfast was primarily caused by your elevated blood sugar before breakfast, that is likely the result of two to three factors:
- missing your evening dose of metformin
- eating later than usual, and
- eating more food than usual.
"Learn from this investigation and try to do better next time," Jim suggests.
You flip your badge over and you are back to being Jim the software engineer.
I am going to speculate that well over half of the time, when a patient has elevated blood sugar levels above what they should be or below what they should be, if that patient plays detective for a couple of minutes, looking for clues that may have caused the high or low, they will be able to figure it out.
In summary, the motivated patient can then initiate steps to prevent the same problem from occurring in the future.
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