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How do I know if my Diabetes is well controlled?

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Over the last few weeks we have been looking at diabetes mellitus or sugar. I have gone into detail on what causes sugar (a partial or complete lack or resistance to insulin, not eating too much sugar) and how you know you have it (eating and drinking a lot and still losing weight). I also looked at how sugar affects you in the short and long term and how we treat sugar (by giving you the actual insulin or medications which cause your body to produce insulin or use insulin better).{{more}} This week we will look at how you monitor your sugar; in other words, how do I know that my sugar is well controlled?

For those patients who have come to see me, you will remember that I always use the analogy of the car engine when it comes to follow up. The analogy is, if you have a car and the engine is bad, how do you find out what is wrong? You get an idea when the engine is hot, but you can only really find out exactly what is wrong if you look at the problem when the engine is cold. That’s when you can “pull down” the affected part and inspect it properly and then fix it. Once the car is fixed and you reinstall the part, then you have to test the engine to see how it’s working. Sometimes you have to make adjustments after, to make sure the engine is running smoothly. Likewise, first you realize something is wrong (losing weight, even though you are hungry and eating a lot of food, drinking a lot of water and peeing a lot) then make a diagnosis (a random, then fasting blood sugar), then you fix the problem (insulin or tablets) and finally you see if the remedy works (monitoring sugar levels and weight gain). I will now discuss the various tests used to diagnose and monitor sugar and how you use them, since there is a lot of confusion among patients about the blood tests.

RANDOM BLOOD SUGAR (RBS) OR GLUCOSE METER READING (GMR)

This is the most common way we use to diagnose sugar. The RBS is the sugar reading taken at anytime in the day after the patient has eaten. This is not a fasting glucose. If the RBS or random sugar is really high when it is first measured (say more than 20mmol/l or 360mg%) then you have sugar and do not need a fasting blood sugar, also called fasting glucose. In other words, if the problem with the engine is obvious, then you do not need to cool it down, to pull it apart to see what’s wrong. It will be obvious because you will see the broken part or the obvious oil leakage or the burnt out area. However, if the problem is not obvious, then you have to cool down the engine and take it apart; in other words sometimes you need a fasting blood sugar to make a diagnosis of diabetes, if it is not obvious from the random glucose that you really have diabetes (sugar slightly or moderately elevated, i.e. between 8 and 15mmol/l).

However, the RBS is really the simplest and best way the patient can monitor his sugar at home, especially if it is done more than once a day of several times a week. Remember this is for the patient at home; the doctor in the office or hospital uses a different test to monitor the sugar control. If you are admitted to the hospital, the nurses will use a series of random sugars, done at different times of the day, to give the doctors an idea of how well the sugar is being controlled. The fasting sugar is usually one of these sugar tests. A lot of patients come to my office boasting that their fasting sugar was 5 or 6 or 7, or somewhere around that, only to be surprised that the reading is 12 or 13 or 14, two to three hours later (in the office), after eating and taking their medication. They fail to realize that having eaten, the sugar will go up, especially if the diabetes is not properly controlled. They are usually very surprised at the level; they are also very confused, as when they visit the “clinic” the nurse usually does the fasting sugar. This is because the nurse is following protocol, but this protocol needs to be updated. I’m not saying that the fasting glucose is useless, but its main (not only) use is in diagnosing diabetes, not monitoring it, while the random sugar is mainly used to monitor sugar control, even though it can be used to diagnose sugar when you are tested for diabetes, if the result is very high.

Next week, we will discuss the fasting glucose.

For comments or question contact:
Dr Rohan Deshong
Tel: (784) 456-2785
email: deshong@vincysurf.com

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