Welcome once again to our weekly advice column, Ask D'Mine, where we talk all about navigating life with diabetes. In this edition, our host Wil Dubois (veteran type 1, author and diabetes community educator) takes on questions that may not only bring you to tears, but could also make you want to log some blood sugars! Read on!


Joey from New England, type 1, writes:  Hey, I was looking over some labs my doc ordered and I saw under the comprehensive metabolic panel the rather oddly named "anion gap." What's that all about?

Wil@Ask D'Mine answers: It's a measure of how many onions you eat. People with a low onion gap are not consuming enough onions. People with a high onion gap are eating too many.


Ohhhhh... A-nion gap. Not O-nion gap. I'm sorry, I misheard you.

Anion gap is the difference between the concentrations of cations and anions in your blood. Huh? Don't worry about it; it tells your doc how acidic your blood is. When it's elevated it may be a marker of anything from diabetic ketoacidosis to drug poisoning to renal failure.

This wide variety of possibilities segues beautifully into my next subject, 'cause anion gap is but one of fourteen different tests that make up the comprehensive metabolic panel, called a CMP in the medical trenches. A CMP tests the levels of junk in your blood. It gives your doc a snapshot of your overall health by showing liver enzymes, markers of kidney function, sodium, potassium, and calcium levels, and more—even our friend glucose!

Because it can pick up on a wide array of health problems, a CMP is part of most annual physicals, especially for those of us who are "chronically ill" with conditions like diabetes. Each value of a CMP is assigned a "reference range" that's considered to be "normal" (but varies from lab to lab, even for the same test) and any value either above or below the reference range deserves a raised eyebrow from one of the white coats.

But, and this is important: Have you seen that TV commercial where the skinny balding doctor (in his white exam coat and stethoscope) is trying to run a jack-hammer and hits a water main? Meanwhile, the burly construction worker is in the drug isle of a big box store trying to choose a med? The tag line is something like "You wouldn't want your doctor trying to do your job, so why are you trying to do his?" There's another version with a lady doc and a violinist, but I think the jack-hammer one is 300% times funnier.

Nothing could be truer about the CMP. Because while any fool with a search engine can look up individual results, the real diagnostic skill is recognizing that if two elements of a CMP are near the top of the reference range, a third is a hair over, and a fourth is near the bottom, it all means something. In short, it's the dance between the elements of the CMP that tell stories, more than the individual results. And developing the literacy necessary to read those stories in a column of numbers is something that takes time, training, and experience. It's not something you can do with Google.

So. Go chop up some onions to treat that onion gap problem, but for God's sake leave anion gap and all the other labs to your doc.


Janet from Maryland, type 3, writes: Help! My 60-year-old type 1 husband is having trouble. His glucose readings are swinging from 38 to 250 multiple times a week! Do you/can you suggest a way to track his food intake?  I think it's important to have a food diary just like his insulin log, which he is great at. We can't get in to see the new doc/dietician for another month, so do you think a food diary will help us see the whole picture? 

Wil@Ask D'Mine answers: I hear your cry for help and I'm doing my Bay Watch dash to come running to your rescue. I think that a food log is a great idea, because an insulin log by itself is about as about as worthless and a submarine with a screen door. Knowing how many units of insulin you took without knowing what you took it for is pointless, so not only would a food log of some sort be helpful, but will probably be the smoking gun that lets you and your medical team sort out why your hub's blood sugars are doing the funky chicken dance.

But how to log that chicken, and everything else he eats? The first thing that comes to mind is to combine it with the insulin log he's already keeping, if there's room. I mean, he's recording it somehow now, so adding a little more info shouldn't be that of a big deal. Even if he's just logging his insulin in a good ol' fashion blood sugar diary, there will still be room to note something like:

BGL 199

5u Humalog

Chicken, rice, six glasses of wine

Or whatever. His dinner last night might have been different from mine.

Recording the very basics of meals (not precise measurements) is often enough to identify trends. Oh. Look at that. Every time I eat potatoes my blood sugar goes too high. Hmmmmm.... Oh. And look at that over there. Every time I eat just chicken it goes low.

Because what looks like a completely random mess probably isn't. There's almost always a hidden madness behind the crazy numbers. You just gotta find out what it is.

Now some people do go to extremes, weighing and recording the most minute details of every meal. While that's a good exercise in precision carb counting in real-time, it usually results in waaaaaaay too much data for your doc or dietician to review, given the realistic time constraints of the modern office visit.

Of course if you are iPowered with iPad or iPhone, or use any other electronic device on a regular basis, that's always an option for logging your meals, too. Back in the day I used Diabetes Pilot on a Palm and found it helpful and easy. And I'll bet there are a hundred other apps for this purpose by now. Being a bit of a Luddite, I find a pen and a piece of paper the fastest way to record anything—I don't have an iAnything at all—so I'm probably guilty of not being up-to-date on all the electronic options. I'll bet our readers won't be shy in comments about what works for them, however.

So maybe I wasn't all that much help on the whole "how to track" part of your question. But I can tell you what to do next.

No matter how the information is recorded, here're my Three Rules for food logs: 1) Do it in real time. Don't rely on your, or his, recall at the end of the day. Record it as you eat it. 2) Be consistent. Do it all the time. 3) Don't cheat. Cheating on your food log is like cheating at solitaire.

Then after a few days go find the three lowest blood sugars and the three highest. Pull out the meal details and write them on a separate piece of paper. What are the similarities? The differences?

I think you'll find the food log, no matter how you record it, is a powerful tool, and probably just the life preserver you need right now.






