"meten = weten"

In this blog I like to explain some basics about how diabetes is monitored, on a daily base and once every three months.   Just in my own words and what it means to me in my daily life.  "meten = weten" is Dutch for "to measure = to know".  But "meten = weten" I think is funny. 

First I will explain what needs to be measured every day.  And this is the value of the blood sugar levels (BGL's) in mmol/L.   This stands for "millimoles" per liter.   For a "normal" person, the mmol are average between 4 and 8.   For someone with diabetes it is the target to have mmol between 4 and 8,  but the mmol can be all over the show.  I have seen mine as low as 2.1 and as high as 23.  Up until the moment I started with the pump, I checked the mmol by finger pricking.  Normally 4 times a day, before breakfast, before lunch, before dinner and at bed time.  But with episodes of too high or too low BLG's, it could be up to 8 times a day.  Now I wear a sensor and luckily I don't have to finger prick that often any more. 

                         

                                 Old and new style of measuring the BGL's  

Unfortunately both ways of checking the mmol are not accurate.  Although you have an idea of what the mmol are at the moment of finger pricking, the value could differ between 1 and 2 points when the value is between 4 and 8 mmol.  When the value is above 8, the difference could even be between 2 and 4 points.  The producer of the sensor advises that the sensor could be 20% off the correct value.  In other words, I actually never know exactly what the mmol is. It is an approximate value.  What even more confusing is that the finger prick value and the sensor value can differ, although measured at the same time.  I hope you understand that this drives me made sometimes.   After the explanation of the second value, I will explain what this can mean. 

                 Which value is correct, the 10.1 of the old meter of the 8.4 of the sensor? 

The second value what is measured is the HB1AC.  This stands for glycated haemoglobin. For a "normal" person this should be between 20 and 40.  For someone with diabetes the target is to be as close to the 40 as possible.  I have seen mine as low as 48 up to 96, when I was just diagnosed.   The HB1AC is measured every three months.  This means that every 3 months I need to go for a blood test.  This is done at laboratory by a nurse, who tries as good as possible to find the blood vessels in one go. 

The result of this blood test will be forwarded to the GP.  For me this feels like every three month I have to do an exam and the GP will tell me that I passed or that I failed and that I have to do it again.  Of course I have "to do it again" as a good result never means that it will be good again the next time.  But  when the GP advised me " HB1AC have come down, well done" if feels like a compliment of a school teacher.  

It is not possible to compare the average mmol with the HB1AC.  A couple of months ago my blood glucose meter gave an average of 9 mmol, so when I was waiting for my result of  the HB1AC blood test, I was hoping that the HB1AC would be in the high 50 or low 60.  I think that you can understand that I was really disappointed that the outcome was 70.   Since I have the sensor, I can look up the average mmol via an app and at the moment this average is around 7.  This could mean that my HB1AC will be in two months time in the mid 40.  If this is really the case,  I will be a real happy diaBEAtic.  I will let you know. 

As I wrote before, the inaccuracy is confusing and also potentially "dangerous".  This is because the predict  amount of insulin required is based on this measured value.  So for example, in the morning, I wake up,  I measure (or at the moment see) that my BGL's are 9.5.  I calculate the amount of carbohydrates (carbs) in my breakfast.  I will explain in another blog about "carb counting" but let's say my breakfast contains 35 gram of carbs.  For me this means I need 6 units of insulin to take care that the insulin compensates my food.  I also want to the BGL's to be between 4 and 8 at lunch time, so I will inject a couple of units more.  (how that works, I will tell also in another blog) . 

For this example, I will give my self 8 units of insulin.  If the 9.5 was too high and as explained,  above 8 mmol, the difference can be 2-4 mmol, and let's say it was 7.5,  I should have injected ( or "advised" the pump) only 6 units of insulin.  This then can mean that around coffee time, I start to feel unwell and I will have a hypo, so BGL's below 4 and this can potentially lead to a coma (mmol 0) .  In my case, I never went really that low, but I had several hypos. This than means that I needed to eat something extra.  Nice of course to have something sweet with my cup of coffee,  but it also caused the weight gain.  

So it is quite a complicated matter.  I constantly think about this,  but I totally understand that it will take some time for, for example, someone who is just diagnosed with diabetes to get his or her head around this. 

One of my next blogs will be about "carb counting" and how to correct BGL's which are to low or to high.  "See you than" 

  

This is an example of the measurements of a full day of my sensor.  This is an extremely good day.  As you see, my BGL's ( the ........... line) rises a bit after I have eaten something but is around target again after 4 hours. 4 hours is the time that insulin does do its work.