The 3Rs – Record, Review, React: A straightforward way to manage your Diabetes #DOC #gbdoc

The 3Rs – Record, Review, React: A straightforward way to manage your Diabetes #DOC #gbdoc
The 3Rs – Record, Review, React: A straightforward way to manage your Diabetes #DOC #gbdoc

I’d like to say I’d thought about this long and hard, and it was the culmination of a life’s thinking about how we can best manage ourselves in terms of dealing with our diabetes. But that would be substantially overplaying my hand. It’s certainly something I’ve contemplated for a while and had a placeholder sitting in my list of topics to write about.

From what I’ve seen from the Diabetic Online Community and what I’ve learned through my life, the day to day reality of managing your diabetes comes down to two things.

The first of these is accepting that it’s your diabetes to manage. Not your GP’s, not the Government’s, not Diabetes UK’s or the JDRF’s. Yours. You have permission to treat it. To make changes. To adjust insulin doses and experiment. Your diabetes team and GP grant that to you. They’d like you to do it. It’s easier for them to manage their interaction with you if you take control. They’d really like you to grasp it with both hands, understand how it works and join the rest of us in the great “My Diabetes Science Experiment”, That’s the first thing to come to terms with.

For many that’s difficult enough. Accepting that it’s all about you and you alone can be a frightening and sobering thought for many people. Even more difficult is accepting that dealing with it is also down to you and that the healthcare profession would really prefer it if you did. But that’s the way it is. It’s a hard truth to learn, and truth be told, many find that difficult. The healthcare system could provide better pointers and information at diagnosis to provide you with a rough map of how to do it, but then, that’s why the Diabetes Online Community is so successful.

So we’ve established that you have to take responsibility for keeping yourself both alive, and in a state where you want to stay alive. Sobering thought, isn’t it?

But how do you do that? Well at its most base, as a Type 1 Diabetic you take insulin in appropriate amounts to keep you alive and your blood glucose where it should be. Now as a Type 2, you need to be working out what to eat to reduce an insulin release and start to reduce that insulin resistance and visceral fat levels. You may end in a similar place to Type 1s and become dependent on insulin as a Type 2 – but the principles remain the same.

Both of these have a common denominator. You need to know how your condition affects you and to be able to base your actions on that knowledge. And the reality of the situation is that there are a limited number of techniques for doing this. So far, we don’t yet have the Star Trek Tri-corder that can continuously monitor you and give you every small detail of what needs fixing and how to fix it! What’s the next best thing?

The 3Rs. And we’re not talking about the scholarly ones here.

Very simply, it’s Record, Review, React. This has an almost fractal quality to it. It works at the base level of a blood test before a meal and at the macro level of reviewing patterns at a day or week basis.

Let’s step through it and understand why.


This is the building block of all management. The simplest component. The atom, if you like. This is writing stuff down. You can make it more or less complicated but it all stems from this. 
Whether you are type 1 or type 2, if you are going to eat, record your blood glucose before eating, the carbs (and fat and protein if you want to) of what you are eating, and any medication associated with the meal. 
Then record blood glucose at two hours after eating. 
Do this every time you eat. Do it in the middle of the night. Do it four hours after you eat. Do it when you exercise. Make a note of when you are stressed, tired, wide awake, struggling to stay awake. Make a record of your activities. Sure, you might feel a little like a pincushion, but you’ll have a record. You need a record to spot patterns.

You might use an FGM device or a CGM device. This makes the Record stage a lot easier and gives you a more easily reviewed record. But it’s a record none the less. 
Keep doing this and that’s the foundation in place.

This is where many people stop. Well don’t be one of those. Carry on with the next two steps and you’ve gone a long way to managing yourself. What are those?


Well, now you’ve got all these data points recorded. You need to do something with them. And that’s what Review is all about.
Whether it’s looking at a meal and the before and after glucose levels to confirm whether your insulin carb ratio is correct if you are Type 1 or if whether the food you’ve eaten affects your glucose levels severely if you’re type 2.
It might be looking at a day, and seeing whether your glucose levels have been all over the place or good and stable, and looking back at that day to determine why. You might check on the times you felt a certain way and what your glucose levels were doing.
It might be looking at a series of days and seeing where you are high and where you are low, and identifying what the common elements of those numbers are. 
It should be all of these. 
As you become more attuned to your condition and the effects of various activities, you can rein in the need to constantly test and review, but this process enables you to understand how you react to what is going on within you and around you. 
It should be done both as a method for seeing how your every day works and then to review any changes you make. Which takes us nicely on to…


You’ve recorded all the data points. You’ve looked at the patterns that are occurring. Now you can make a decision as to what you need to do next. It might be “Nothing” if everything is working as it should. 
It might be that you consider changing an Insulin:Carb ratio, or choosing not to eat a certain food type as a result of seeing what has happened. 
You may choose to change the timing of insulin or undertake a basal test. You may elect to combine foods together to test the impact on your glucose levels. 
You might decide that counting carbs is not enough and you need to look at protein as well. 
You may decide that you need to see a Diabetes professional to help you sort out some issues that you have identified. 
All options are valid. All are reactions. All come from reviewing your records. Some of the common ones can be found here.
And once you’ve made a change, the cycle continues.

You want to manage your diabetes? You need to know what it is doing, and this is a straightforward way to do it!

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