Diabetes Self-Management Blog

It wasn’t until about eight years after I was diagnosed with Type 2 diabetes that I was told to check my blood glucose. It would be another year before I was told how to check—when to check, what numbers to strive for, how to write them down so a pattern could be seen, how to adjust for highs and lows. Long before the next year had ended, my HbA1c had dropped from double digits into the 7th percentile. One of the biggest contributors to that was learning how to interpret my blood glucose readings.

Now comes word from British researchers that non-insulin-using people with Type 2 diabetes don’t necessarily need to check their blood glucose. It really doesn’t make a significant difference in control, they said in a research article published in the June 25 issue of the British Medical Journal. Besides, they added, it’s expensive and insurance companies don’t really want to pay for it. You can access the article here.

“It makes me very angry when [health care agencies and professionals] use this kind of research in order to restrict access to test strips,” wrote one British subject with Type 2 diabetes who has benefited from checking her blood glucose.

As one of the people who testified in favor of insurance coverage of diabetes-related supplies, drugs, and education in my state (it passed), I can tell you that insurance companies surely don’t want to pay for more than they absolutely have to: I sat through their testimonies, too.

I’ll disregard the fact that the researchers should have used subjects with average HbA1c levels higher than 7.5% so blood glucose values in the intensive intervention group could have had farther to go than -0.17% from the control group.

Instead, I’ll just say that instead of throwing obstacles in our paths and then complaining that many people with diabetes are out of control, the powers that be should be providing us with meters and an adequate amount of test strips to provide necessary information, as well as education to help us interpret that data.

There are many benefits to checking your blood glucose levels:

  • If they’re written down properly, it’s easy to detect patterns. When I was first told to check, I wasn’t told how. I merely had a jumbled mess of numbers until I was told how to list the results, with each meal in its own row. When I did that, patterns became clear at a glance and I knew immediately where my problem areas were.
  • Want to see how a particular food affects your blood glucose? Check both before you eat it and then two hours after you take that first bite.
  • How does exercise—or different forms of exercise—affect your blood glucose? You won’t know unless you check before, after, and maybe even during.
  • Do you need to make a change in your diabetes medicines? How will you know what to tell you doctor unless you check to see if you’re running too high or too low?
  • Planning to drive someplace? If you take a medicine that lowers blood glucose levels, checking before getting in the car can tell you if you have or are in danger of developing hypoglycemia. I have a friend who very proudly told me she didn’t have to check her blood glucose levels; her doctor had told her “it’s not for everyone.” So when she was out and began sweating and feeling dizzy, she got into her car and drove to the doc’s office to find out what her blood glucose was. I’m glad I wasn’t driving on the same road as she was.

The British researchers appear to believe that merely knowing your HbA1c is sufficient to assess your diabetes control. But it won’t help you with the above list. Only checking and acting on the results can do that.

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Comments
  1. Soooo…..I was hoping your article would give some details on your opening sentence: “It wasn’t until about eight years after I was diagnosed with Type 2 diabetes that I was told to check my blood glucose. It would be another year before I was told how to check—when to check, what numbers to strive for, how to write them down so a pattern could be seen, how to adjust for highs and lows.”

    Posted by anna |
  2. I absolutely agree with you. When I was first diagnosed 4 years ago my HbA1c was 13.8. It took me just over a year to get my H1c down below 7 and testing my glucose levels was crucial to doing that.

    Posted by Moviejunkie32 |
  3. October will be 2 years I was diagnosed with type 2 diabetes. With a good diet and some exercise I remain at 5-7% levels. I check levels 2x a day and feel I have better control. Last week I drove to the shore(60mi),walked the boards in the sun about an hour and began feeling tired. I went indoors and rested, had dinner and returned home (wife drove). I took my sugar and it was 65. This was frightening. I sat back, drank orange juice and did another check. Sugar increased to 79. It’s good to be in control not left in the dark.

    Posted by Tom |
  4. I too would like the details of what you DID learn–eventually. “…when to check, what numbers to strive for, how to write them down so a pattern could be seen, how to adjust for highs and lows.”

    I remember my first meter had a book to record the numbers in but that has long since been filled and the practice dropped. And, I’m falling back into old eating habits–not good.

    Posted by mem |
  5. I would be lost without checking my blood count daily. It helps me so much in controling what I eat, and what effect a particular food has on my blood count. I would be eating all the wrong things and/or portions (especially portions) and my blood numbers would cause me to be on medication or insulin. The British researchers are not showing me much about their “research.” I trust my doctor, and what he tells me to do helps me control my Type 2 diabetes. Diet and exercise is what works best for me.

    Posted by Rose |
  6. About the value of a HbA1c test.

    I am not at all convinced that this test provides us accurate numbers; the test is more of an average result; a status that is often forgotten. There is evidence that some persons with diabetes can skew the results just before going for a test One of my doctors knows this for sure.

    However, the test seems to be better for us than without; both for Type I and Type 2 diabetes; perhaps even LADA! It is a tool that helps us to remain on or close to target and provides some clue to whether we ARE in control.

    Posted by Joan |
  7. I diagnosed myself as being diabetic with my first meter. After having just about every symptom there is for many months someone suggested that I might be diabetic so, I went and bought the cheapest meter I could find so I could see for myself before I went to the Doctor. Sure enough my Glucose level was over 600! From the very begining I’ve used my meters to see how different foods affected me and how to reconize the highs and lows. Every diabetic should have at least 1 meter,plenty of strips and the knowledge to use them!! It’s the only way to know what’s going on with your particular situation. I think these Doctors are just lobbying for the insurance companies. How would they like their children riding a bus being driving by a person with a BG of 33 because they didn’t check it before they came to work!!

    Posted by Jerry |
  8. Wonderful article and I concur wholeheartedly that monitoring our glucose levels is a tremendous aid in managing our numbers.

    I would like detail also on how you wrote your results down and discovered patterns. No one has ever told me about that and I was diagnosed 7 1/2 years ago.

    I recently began to use Avandia along with Glipizide and Glucophage. Its scary reading the latest studies regarding Avandia and should I stay with it. My older medicines no longer work too well but with Avandia I’m having excellent results. Without my meter, I would have no clue.

    Thanks for being on point with the monitoring story.

    Posted by Kuinilady |
  9. I agree with Jan Chait. Checking BG is esssential to good control and managament of a person’s diabetes. Her reasonings are well stated and I find testing frequently helps me in making decisions about my diet, exercise, etc. It also helps me to see lows and treat them as well as highs. Self monitoring of blood glucose is essential to good care. To tell a patient it is not necessary is foolhardy and can be dangerous as well.

    Posted by deafmack |
  10. Several of you have asked about how to write your results down. I will blog about that next week.

    Posted by Jan Chait |
  11. I have a few comments with reference to the British evaluation.
    To qualify the patients training:
    I would ask the patient explain why they are testing their BG.
    Do they know the doctor is trying to control the BG between 80 and 140?
    Do they know BG’s above 140 does damage to the veins and organs?
    Can they convert a A1c into a BG average?
    If any question is a failure perhaps the British training needs to be re-evaluated.

    The report goes to great length to qualify the testing. The point seems to be the expense of the test strips. Rather than eliminating a tool the Diabetic needs to fight this progressive disease, perhaps we need to develop a re-useable test strip. Nothing brings down the price like competition. I have read about tattoos and contact lenses that would change color with reference to the BG level.

    Regards,

    Danny

    Posted by Danny, Greencastle, PA |
  12. I also disagree with this research. It has to be biased in some way. When I was diagnosed with Type 2 six years ago my A1C was extreemly high. It was over 15. Live style changes, metformin, and frequent Blood testing brought my next A1C to 5.7. Testing makes me aware and it also makes me conscientious. My A1C has remained good ever since. In fact it varies from a low of 5.0 to a high of 6.0 depending on how hard I try to control it. Not testing is just plain stupid in this modern age.

    Posted by Burbot |
  13. At about the same time this research came out, I was on stage at ADA Scientific Sessions delivering very exciting research that contradicts the UK trial conclusion.84% of Type 2 Trial Participants Reduce A1c Over 1 Point w/ Frequent BG Checks

    The missing information here is did the UK researchers assess if these patients were equipped to strategically measure, understand and act or were they just burning strips?

    The patients in our trial were taught glucose pattern analysis and given education about cause and effect, bg experimentation w food choices, activity, etc… And, we made it simple by using a wireless glucose meter and sophisticated rules engine technology to automate data collection, analysis, education, logbook delivery, risk alerts, etc…

    So it’s not if you test or if you don’t. It’s about when, why and what do you do with the data.

    Posted by Kevin McMahon |
  14. mem I don’t know what company you have your meter from, but mine is Bayer. Bayer, and possibly others, will provide their customers with free log books. Just call your meter company and ask. I can also get control solution and batteries for free. Plus, since I had registered my old meter, when it became extinct, they sent me a letter allowing me to get a new model free, my choice.

    Posted by Ephrenia |
  15. I totally agree with you about testing. It makes life much easier when you know what your blood sugars are at different times of the day. The better your blood sugars are, the better you feel.

    Insurance companies should be helping people live better lives without caring about the cost.

    Posted by Carol J Thompson |
  16. Ummm…not to be rude to old people (I plan to be one some day, God willing!) but the very first thing that struck me was that the AVERAGE age of study participants was 65 point something. Hmmmm….gee, wow, could that be a factor? I’m 50, and I KNOW that I’m way more motivated than my almost-80-yo father-in-law. And that’s perfectly understandable! If I were his age, I’m sure I’d be less about keeping strict BG control and more about enjoying whatever years might remain in my life. Just goes to show you that any survey or study can NOT be taken at face value. Question authority! ;)

    Posted by mcdulph |
  17. I am a type 1 my diabetes is a strange one my sugar level get low as 24 before I pass out (because I have had so many lows i have no warnings) and get high as 1500 but I am interested in the contact lens reading

    Posted by JOHNP |
  18. I just got a letter from my doctor.
    I just went for a routine physical.
    He said my fasting blood sugar was 120
    He said my H1C was 7.9
    I have to call him for a consult.

    I will not get to talk to him for 2 weeks as I am away.

    Can someone give me the name of a book, what I could read to understand more about what these tests results mean??

    Barry

    Posted by BARRY |
  19. Hi Barry,

    A good place to start reading would be in the Diabetes Basics section of this Web site. The article “Navigating Your Way to Optimal Health” answers the questions you posed about blood glucose and HbA1c numbers.

    As for books, Gretchen Becker’s The First Year Type 2 Diabetes is a good one to start with.

    Best of luck.

    Posted by Tara Dairman, Web Editor |
  20. I need a sheet or book for recording my glucose levels and cannot find one on any website I go on.Please tell me where to find one.

    Posted by Mary U. |
  21. Mary, there are a variety of sheets you can choose from at http://www.insulin-pumpers.org/logbook.html. Also, try calling your meter company and ask for a logbook. My endocrinologist’s office used to give me logbooks or sheets (I download my meter now and take the reports to my visits). A diabetes education center may have some available. The Diabetes Mall sells themn - go to http://www.diabetesnet.com/mocb1.php. And, I’m not sure, but pharmacies may have them available. You can also make your own - as simple or as complex as you’d like.

    Hopefully, one of those places can help you or at least get you started.

    Jan Chait

    Posted by Jan Chait |

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Blood Glucose Monitoring
Blood Glucose Monitoring: Minimize the Pain, Maximize the Gain (08/15/14)
Potential A1C Test Alternative; Glucose Meter Recall (01/21/14)
Why Do Test Strips Cost So Much? (Part 2) (09/25/13)
Why Do Test Strips Cost So Much? (09/24/13)

 

 

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