When your doctor diagnosed you as having diabetes, did he issue you your detective's badge right then, on the spot, or did it arrive in the mail a few days later? Oh, it doesn't make much difference either way as long as you start wearing it soon after you get it.By the way, do you think people with diabetes should wear their badge all the time or only for two to three minutes immediately after eating? My thinking is that it should be left up to the person to see what works best for them.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 if nobody has told you already.Let me test your current level of knowledge and then let's say we build on that.Have you ever watched any of the police or crime shows on TV? Of course you have, probably hundreds of them.It seems to me that they all begin about the same.The scene opens like this.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.(Of course it's dark out, it's three in the morning.) A partial view of a crowd standing around something, usually a dead person, also commonly referred to as the victim.You hear a slamming car door and see footsteps entering the picture.The camera pans upward.You see Sanders, now in some sort of a long coat, holding a steaming Styrofoam cup in his left hand.A uniformed officer comes up.Sanders speaks."Hey Johnson, what do we got?".The uniformed cop reads notes off his very, very, small note pad."White male, approximately thirty - forty 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 matter of factly.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 ever written starts off with a murder being committed.Then what? A detective appears on the scene, asks lots of people lots of questions, looks for clues, evidence, anything that would help the detective solve the crime, and then, just before the end of the show, with about 6 or 7 minutes left, the detective has enough information to solve the murder.So again, what does this have to do with you, a detective's badge and 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?Whether it's too high or too low, it's dangerous.Lows are dangerous now and highs will cause serious problems in the future.In either case, the cause of the highs and lows needs to be identified.I have told patients and emphasized to them many times, that if you check your blood sugar, find it to be too high, and respond by saying, "Whoa, that's a high blood sugar," put your meter away, and then go on about your business, then there is little point in testing your blood sugar levels.Conversely, if every time you get a reading that is too high or too low you, figuratively, pin your detectives badge on your shirt and begin looking for clues as to what caused the high or low, then that is worthwhile, something that can lead to better management of your diabetes.I tell patients that the day they develop diabetes, they need to accept the role of detective.Let's say you test your blood sugar 2 hours after breakfast on a Monday morning; you have just gotten settled at work, 227mg/dl.Hmm, 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.You begin by asking yourself some very straightforward questions using the best Rod Serling voice you can muster, albeit in a hushed tone.You don't want the people in the next office to hear you."So Jim, why is your blood sugar level so high two hours after breakfast? What could have caused it?" There is a pause in the questioning as you think for a moment.You answer yourself, honestly, as if you are under oath."I don't really know," you say."Is it possible you ate too much for breakfast?" Detective Jim asks."No, I counted my carbs, only had about 50 grams, 60 at the most, which is on my meal plan."."Well tell me," continues Detective Jim, "did you happen to check your blood sugar before breakfast, and if so what was it?"."As a matter of fact, I did, and it was 180mg/dl."."So, actually, what you're telling me is that your blood sugar was high when you sat down to eat."."Yes, sir."."Don't call me sir unless you want me to call you sir."."Ok, that is correct, my blood sugar was high before breakfast.".(Imagine how Rod Serling's voice would sound when he has just figured out something and apply here, well, the next sentence.)."So if it was high before breakfast, isn't it likely that it would be high after breakfast, even if you ate the right food?"."Well, yeah."."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?"."Sleeping."."Ok, how about two hours before that."."Still sleeping."."And finally, two hours before that."."I had just gone to bed."."What you are saying then is that you were sleeping for six hours just prior to waking up.Is there anyone that can verify that you were sleeping for six hours before you woke up?"."Yes, my wife.".(If you are going to be a good detective, you can't be afraid of asking the tough questions.)."The reason I asked that is because if you were to get up and go to the bathroom sometime during the night and on the way back to bed you stopped by the kitchen for a glass of milk, or an Oreo, or two, or sometimes even three, then you can expect to have a high morning blood sugar."."No, I never eat anything in the middle of the night unless my blood sugar goes down too low."."Ok, is it possible you forgot to take your diabetes medication last night?"."Let's see, I'll tell you what happened.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's 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.Missing one dose of a medication is sometimes all it takes to allow your blood sugar levels to become elevated.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 2 hours later than I usually do, and I ate more than I usually eat.Some friends of ours were in town that we had not seen in about 15 years since we moved from Seattle to Tampa, so we could be near my daughter, Madeline, who is almost 27 now and is married with 4 lovely children, ranging in age from 2-7.They are the cutest things and I tend to spoil them.We went out to dinner with them and I think we ate too much."."First of all, just the facts sir, save the gushy stuff for your friends.Please don't go off like that again."."Sorry."."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."I feel terrible, so guilty," you whine."Don't, just learn from this investigation and do better next time."."Ok, it's a deal, thanks for not being too hard on me, Jim."."You are quite welcome.It's been a pleasure investigating your case.See you next time your blood sugar is too high.Bye now.".You flip your badge over, back to being Jim the Software Engineer.I am going to speculate that well over half of the time, probably three quarters of the times that 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.Once this is done, the patient may be able to say something like, "After playing detective with my blood sugar readings for about a month, I noticed that about 80 percent of my high blood sugars were the result of apparently eating too much dinner.Once I started eating less at dinner, my blood sugar levels and HbA1C improved dramatically.In summary, the motivated patient can then initiate steps to prevent the same problem from occurring in the future.
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