We aim to replace static diabetes management with a dynamic in the moment method. An excerpt from Chapter 4 – A Force For Change “… In the grand scheme of diabetes self-management, I explain to patients and families that I (the doctor) don’t “manage” anyone’s diabetes. My role is more like that of a coach, occasional cheerleader, mentor, and at times role model I suppose. It truly is the sum of your choices; not mine or your doctor’s. Simply receiving diabetes education is often not enough. I see a three step process at work, and often times we barely get past the frst step. What we call “diabetes education” is intended to result in understanding on the part of the person(s) receiving it. But that is not the fnal element. Understanding should translate into behavior or actions for the education “loop” to be intact. There are many highly intelligent and understanding individuals in the criminal justice system who are well educated and understand all too well their actions, even the illegal ones. So what does all this have to do with using a CGM? In my opinion, it means all the difference in the world. It morphs a CGM device from a simple high or low blood alarm system (not a bad thing by itself) into the key for unlocking a vast new universe of diabetes self-realization that could once only be dreamed about. Basic diabetes self-care can be drawn as a decision loop. This loop is actually being executed daily by most persons with diabetes albeit often in a mindless fashion. Turning this chore into a more mindful action loop transforms this into an incredible tool for attaining the best blood sugar control possible for you. Like any loop, Sugar Surfing has no beginning or end. I tend to jump in at the point I call “monitoring”. This embodies many inputs both measurable and subjective. Most of us think of the act of measuring a blood sugar level with a meter or CGM device. But it’s more than that. It’s also being “in the moment”. That means being aware of recent, current and impending actions that are known to affect the ebb and fow of blood sugar levels in the body. Since blood sugar levels can be unpredictable, staying “in the moment” is a about the only approach that works for anticipating, or at least quickly reacting to unexpected shifts in BG. Once the status of the system (your body) has been sized up, either through the act of measuring a glucose level or glancing at the screen of your CGM device (or both), the next step is to analyze what is going on. This involves pulling in memories of recent actions (last insulin dose, most recent bout of exercise, what and how much was eaten (or will be soon) and more. The analysis step is where all of the little inputs come together for a final determination which is the next step: decision- making. Deciding is prioritizing one or more actions based on all the possible actions. The one that seems to be the best option is placed at the top of the list to be acted upon. Back up options are most likely numerous, but an initial action is required. The fnal part of our loop is execution: the act of following through on our decision. Immediately afterwards we are moving back into monitoring to determine the effect of our action and then modifying it as needed. You are probably saying “I already do this” and you would be right. But as has been written about by many authors, many of our decisions are mindless as opposed to mindful. This loop is a skill as much as it is a process. And as such, skills are practicable and can improve over time, or grow rusty with disuse.

Sugar Surfing: How to manage type 1 diabetes in a modern world PDF

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