Monitoring Blood Sugar
When I first started practice in 1980, Doctors were just started to monitor blood sugars in the office but the machines were too cumbersome to become popular for everyday use. By the middle 1980s, the ability to obtain a blood sugar with a drop of blood taken from the finger started being used by patients in their homes and by the early 1990s almost every patient with diabetes was encouraged to check their sugars. Patients were able to use these numbers to see the effect different foods had on their sugar and modify their diets. Patient charted their sugars and Doctors would use these charts to adjust oral medication, insulin, or to give advice about exercise. Rather than relying on one blood sugar measurement to guess at control, doctors were able to get a much better idea about control because they could see the blood sugars at different times of day and different days of the week. As computers became more sophisticated, doctors and patients became able to download the results of the monitor into different computer programs to analyze blood sugar trends. Patients who did not stick to their diet would often “forget” to bring in their charts or monitoring devices. Because of the difficulty sticking to a diabetic regimen there would often be tension between the doctor and the endocrinologist
In the late 1980s a hemoglogin a1C test was developed and implemented. This test provides an estimate of blood sugars over a 3 month period. It helped doctors understand how well an individual patient was controlling his sugar. By combining the results of the hemoglobin A1C with glucose monitoring, Doctors were able to understand how well a patient was controlling his sugar and enabled him to improve control. After control could be measured, the correlation between good diabetic control and the complications of Diabetes was finally proven and Doctors and patients were encouraged to get the sugars as close to normal as possible. Patients took much of the responsibility for controlling their disease because they could now see the numbers they were trying to control. When visiting the doctor’s office, they anxiously awaiting the results of their A1C as a student waits for the results of their exams. Some patients have attached so much emotion to their numbers that they see themselves as failures if the numbers are high and are now encouraged to see these numbers as feedback ie opportunities for improvement.
