the same. Jill and Jane are experiencing big, out-of-control swings, and Joe and John are not consistently in the 70–140 mg/dl range. Having this type of information can put your A1C results into perspective.
WILL CONTINUOUS GLUCOSE MONITORING REPLACE A1C?
Continuous glucose monitoring (CGM) appears to be the future of self blood glucose testing. By using a device that continually checks blood glucose levels, these systems provide a complete view of levels throughout the day, improving glucose management and overall self-care. However, CGM devices aren’t perfect yet and many are expensive or hard to get; more work certainly needs to be done. Whether they will replace A1C tests remains to be seen, but it’s hard to imagine that an overall glucose snapshot of a 2–3 month period won’t be useful in the future. Likely, CGM will be an excellent tool to use alongside an A1C check. For now, all individuals with diabetes, whether they use a meter, or CGM devices, should have an A1C check to be evaluated alongside daily readings, whether from a meter or a properly calibrated CGM device.
DO YOU STILL NEED TO KEEP A BLOOD GLUCOSE LOG BOOK?
There’s no replacement for a well-kept glucose log book. Always take your logbook (or a meter with a memory function) to appointments. Ask every member of your health care team to review the information, including your educator, nurse, pharmacist, or dietitian. Compare your logbook results with the A1C results on a daily, weekly, or monthly basis and not just every 2–3 months.
MORE RESOURCES TO EXPLORE
BOOKS
Diabetes A to Z: What You Need to Know About Diabetes—Simply Put, 5th edition. American Diabetes Association; Alexandria, VA, 2003.
WEBSITES
American Diabetes Association Website ……. WWW.DIABETES.ORG
3 How to get the most out of your visit to the registered dietitian
Visiting a registered dietitian (RD) seems to be as popular as going to the dentist to have a cavity filled. Maybe less so. Perhaps people cringe at the thought of exposing their personal food choices and body weight to a RD. Perhaps they expect to be scolded or judged. Unfortunately, many physicians have not exactly helped put these perceptions to rest. In some cases, the physician may even use the threat of an appointment with a RD as some strange motivational tactic to encourage patients to change behaviors. Not surprisingly, this tactic doesn’t work, but it does turn the RD into the boogeyman. In other cases, health care professionals will make offhand, negative comments such as, “You won’t be able to eat THAT anymore,” and then set up an appointment without a patient’s consent, creating a scenario where the individual anticipates having things taken away from them before they even step through the door.
Here’s the good news about a referral to a RD—it is not punishment, it is valuable. The RD is a vital member of your diabetes health care team and a terrific source of nutrition information. In fact, most people find that a RD expands their food choices as opposed to limiting them. Considering the other options for nutrition education—food advice from a copied menu or an article from a popular magazine—it’s not surprising that most enjoy the special attention and conversation
WHAT’S A RD?
Once you realize a RD is not a dietary dictator or the food police, you might wonder what a RD actually is. Following are some characteristics all RDs share.
DOES A RD VISIT COST MONEY?
A visit to the RD will likely mean an out-of-pocket cost. Find out from your insurance company in advance what will be covered and what will not be covered. Medicare does provide coverage for meeting with RDs under certain conditions, and many private insurance policies will cover appointments if the RD is associated with an American Diabetes Association Recognized Diabetes Education Program or American Association of Diabetes Educator’s Accredited Program (see the box How to Find a Professional). With so much “free” nutrition information out on the web, on newsstands, and in magazine racks (some of it valid, most of it utter nonsense), many people wonder why they should pay a RD. It helps to remember they are medically and professionally trained and they are working with you. There is a lot of free general medical advice available as well, but we still understand the importance of visiting our doctor for a checkup. The same is true of a RD.
WHAT WILL YOU GET FROM YOUR VISIT?
Meeting a RD is much more personal and useful than being given a free “diet sheet” from a tear pad at the doctor’s office. Why? Because you are an individual. From the minute you started putting food in your mouth, your reaction to food was unique. At about 12–18 months old, when you became independent with your spoon, you gained control of what you did and did not put in your mouth. From that time on, you learned to make your own choices.
An individualized plan designed for people with diabetes allows choices as well. How could a copy of a preprinted 1800-calorie diet with a one-day menu possibly work for everyone? People with diabetes come in different ages, sizes, and shapes and each has different medical needs. One plan does not fit all. To make sure you get the most of your appointment, ideally ask for a consultation with an established American Diabetes Association Recognized Program or American Association of Diabetes Educator’s Accredited Program. Look for someone
