Use a Diabetes Journal to Monitor Blood Glucose
Why Tracking Can Help
In the age of smartphone apps and online trackers, journals might feel like an ancient tool. However, journals can help people sort out feelings, monitor spending habits, and document their lives in a tangible way. For a person with diabetes (PWD), a journal that documents their diabetes management can be a powerful tool.
Tracking one or more elements of your diabetes care can help you and your health care providers learn about your current habits and actions. Benefits include:
• monitor and lose weight
• manage blood glucose
• discover eating habits and behaviors
Your success with a journal depends on how honest and detailed you are in your reporting. Used effectively, journaling is a data-proven method for losing weight, managing blood sugar, and discovering and changing eating habits.
Get our tips for using (and following through with) a diabetes journal, and see how other people with diabetes have used it for their own weight loss and diabetes management. Of course, if you love your apps, trackers, and digital tools, use what works best for you and keep up the good work.
What to Include in a Diabetes Journal
The information recorded in a journal varies, although some basic things should always be included, such as what and when you ate.
Malena Perdomo, RD, CDE, a spokesperson for the American Diabetes Association-Colorado, gives her clients a journal with places to record what they eat as well as their blood glucose levels before and after meals. She also offers a more extensive journal that has a spot to list grams of carbohydrate at each meal. And if a person has risk factors for heart disease, there's a place to record fat grams.
Other things to record in a journal include when you take medications, your physical activity, and how you're feeling.
At the minimum, try a journaling for two weekdays and one weekend day. Registered dietitians recommend at least this much to get an idea of how much food you typically eat. You can also use the journal entries to create a personal meal plan.
Real-life example: Madline SaBell, who has type 2 diabetes, regularly keeps a food journal. "It's helped me a great deal," she says. "When you see it on paper, things start to click. You look back and say, 'Wow, I ate all of that!'"
What Journaling Can Do for You
There are six diabetes-related questions a journal can help to answer:
• Am I eating healthfully?
• Am I eating consistently?
• How does eating affect my blood sugar?
• Are my medications working?
• How does exercise affect my blood sugar?
• Do I eat more when I'm upset, happy, bored, or sad?
"The biggest benefit of a journal is that people start to really understand the connection between diet, exercise, and blood sugar," says Perdomo. "We talk about how food affects blood sugar all the time, but sometimes that connection doesn't seem real until someone sees it on paper."
Real-life example: Betty VanCleave, who has type 2, noted changes in her blood glucose once she started a food journal. "If I ate too much pasta at night, I would see it in my blood sugar the next morning." The journal also showed that she wasn't eating many fruits or vegetables, and that she often forgot to eat breakfast.
The Golden Rule of Journaling
The No. 1 rule of keeping a diabetes or health journal: Be honest. Do it well or not at all. That mantra has merit when it comes to tracking your health and behaviors. Remember that when keeping a journal, you're doing it for you—not to please your dietitian or health care provider. Be honest when filling it out. Don't say you ate a burger when you really had a cheeseburger or wheat bread when you had white.
The following six tips are from Malena Perdomo, RD, CDE, on how to keep a diabetes journal that provides the most helpful results.
Tip 1: Note When You Eat
What to note: List what times you have snacks and meals. This will show if you tend to skip meals, eat too little, or eat too much at certain times.
What it means: Examine these times. Do you eat every three to four hours? Do you save up all your calories for one meal, maybe skipping breakfast and lunch and then having a big dinner? For people with diabetes who take no medications or only one or two blood glucose-lowering pills, regular meals containing enough but not too many calories can help smooth out blood glucose levels and tame hunger pangs. Talk to a diabetes educator or dietitian about an eating plan that’s right for you.
Tip 2: Note What You Eat
What to note: This seems obvious, but you need to make sure you list amounts and detailed descriptions of the foods you eat, such as 1/2 cup mixed fruit or 3 ounces grilled chicken. Use this information to assess your portion sizes. Not sure how much you're eating? Get out the measuring cups and consider investing in a good food scale.
What it means: Are you eating a lot of foods high in carbohydrate? Are your portions larger than you thought? Although not all food journals include fat and sodium, they're good to list -- and they're a must if you have heart disease. Fat and sodium can hide in many foods, especially restaurant meals and convenience products, so it's easy to misjudge how much you're eating. Take the time to research restaurants online and read food labels to better understand the nutrients you're getting.
Real-life example: Betty VanCleave, type 2, lost 25 pounds by using a food journal. "The journal showed me that I was eating too much," she says. "My portions were way off. What I thought was a cup was really a lot more." After making changes to her meal plan, VanCleave said her weight started to drop and she felt better. "It definitely made a difference. Writing everything down is time consuming, but the health benefits are rewarding."
Tip 3: Note Your Blood Glucose
What to note: Note your fasting glucose level (before breakfast). If you don't already, consider checking before and two hours after your biggest meal of the day to see how meals affect your blood sugar levels.
What it means: How different are your blood glucose readings before eating? Do you notice any change on a morning after a big dinner? What happens if you skip lunch and have a bag of chips in the afternoon? Understanding changes in your blood sugar and how foods affect it is one of the biggest benefits of keeping a journal.
Tip 4: Note Your Medications
What to note: Note when you take oral or injectable blood glucose-lowering medications and how much you take to observe how they interact with the timing and contents of your meals.
What it means: Noting the amount and time of doses can help you pinpoint what medication timing works best for you to avoid out-of-range blood glucose levels.
Tip 5: Note Physical Activity
What to note: Write down the type and minutes of formal exercise, such as walking or biking, as well as any informal exercise, such as gardening or housework.
What it means: Daily exercise is important for weight loss, so noting it can help you make sure you get moving for a total of 30–60 minutes each day. Completing exercise early in the day is best for getting it done, but you may want to choose another time based on your schedule and blood sugar levels at certain times of the day.
Tip 6: Note How You Feel
What to note: Jot down how you feel physically (tired, weak, energetic) and emotionally (angry, stressed, bored). This is a step toward learning to decipher true hunger pangs from emotional hunger or cravings.
What it means: Emotional eating is a big culprit when it comes to weight problems. Recording your feelings helps you see how foods affect your body physically and how emotions affect what you eat. By noting and thinking about feelings associated with food, you'll get better at distinguishing true hunger from the desire to eat a box of cookies because of a bad day.
Real-life example: Madline SaBell, type 2, credits her journal with helping her see how stress was affecting her diet and blood glucose. "I'm now more alert to how I'm reacting to things in life," she says. "With the journal, I could see the connection between what I ate, how I felt, and how I was affected by things I couldn't control, like traffic or the weather."
Set New Goals
After keeping a journal for at least three days, the next step is to look it over and see if you notice any areas for improvement. When Perdomo reviews food journals with her patients, many are surprised to see how their choices affect their blood sugars. That realization motivates them to make changes and set new goals.
"I want people to make changes that they want to make," she says. "If a person enjoys having a big dinner at night, we'll find ways to work with that." Or if a person isn't ready to commit to a fitness program, Perdomo suggests setting walking goals. But in the end, it's up to the individual.
"It used to be that we gave strict food plans to people with diabetes," Perdomo says. "But now it's all about self-monitoring and taking control of your health. I give them the tools—and the food journal is one of those—but it's up to them to use those tools."