Is Self-Monitoring a Waste?

Self-monitoring of blood glucose for people with Type 2 diabetes is often a contentious topic. There is little doubt, of course, that for people with diabetes who take insulin, self-monitoring plays a crucial role in calculating the correct dose, allowing for far better blood glucose control than would otherwise be possible without a very high risk of hypoglycemia (low blood glucose). But for people with Type 2 diabetes who don’t take insulin (or an oral diabetes drug that carries the risk of hypoglycemia), there is longstanding debate about whether self-monitoring is worthwhile, with some experts arguing that it is a waste of time, money, and effort for most people.

Two major medical organizations have just taken a side in this argument. In their contribution to the American Board of Internal Medicine’s “Choosing Wisely” campaign — an initiative in which medical organizations submit a list of “Five Things Physicians and Patients Should Question” in their field — The Endocrine Society and the American Association of Clinical Endocrinologists put self-monitoring first on their list: “Avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.” They go on to note exceptions when monitoring is a good idea for everyone, including during illness, when new medications are added, or if HbA1c begins to rise. But the groups note that self-monitoring appears to have little benefit unless it is used to learn how foods or activities affect blood glucose, or to adjust diabetes treatment in some way.

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David Spero addressed the topic of “Mindful Glucose Monitoring” in a blog post here at DiabetesSelfManagement.com last year. In the dozens of comments left in response to his post, readers took both sides in the self-monitoring debate. While some noted that self-monitoring allowed them to learn how foods affected them following their diabetes diagnosis, others questioned whether their current self-monitoring routine was doing them any good. Some wrote that they kept a log of their numbers for their doctor but did nothing else with their results, and that their doctor only quickly skimmed the numbers. Yet those who used self-monitoring to learn about their response to foods tended to view it as indispensable, even if they stopped monitoring frequently once all of their favorite foods and meals had been covered.

People with diabetes aren’t the only ones arguing about self-monitoring — doctors are, too. In back-and-forth commentary and letters published in the journal Diabetes Care several years ago, a self-monitoring skeptic noted that in most randomized controlled trials of self-monitoring for people with Type 2 diabetes who don’t take insulin, no significant difference in HbA1c level has been seen as a result of monitoring. Proponents of self-monitoring noted that in a meta-analysis (combined analysis of several studies), they found that people not on insulin who self-monitored had an HbA1c level 0.39% lower, on average, than those who didn’t monitor, with the resulting lower rate of diabetes complications offsetting some of the costs of monitoring. The self-monitoring skeptic countered that the enormous sum of money spent on self-monitoring — estimated at nearly $1.5 billion each year in the United States — could probably do a better job at lowering diabetes complications if some of it were put to a different use (for example, paying for diabetes education). He notes that if self-monitoring were a drug, the US Food and Drug Administration (FDA) most certainly wouldn’t approve it for people who don’t take insulin, based on its rate of effectiveness at lowering HbA1c.

What do you think — if self-monitoring necessary or helpful for people with Type 2 diabetes who don’t take insulin? If so, is routine monitoring helpful, or is it only useful at certain times, such as when trying new foods or during illness? Should doctors and patients take cost — direct or indirect — into account when deciding how often to self-monitor? Would you self-monitor as much as you do if you had to pay the full cost of your test strips? Leave a comment below!

  • Deb

    Totally agree, waste of time and money…but most importantly painful to fingers, reminder of illness and cumbersome lugging meters and strips when traveling.

  • Terri

    No it is absolutely not a waste. I don’t do it after I’ve had a meal that will raise my levels more than negligibly. That’s because I know I’ve been bad. :( But it does keep me on my toes. :)
    It’s a good feeling to know that resorting to food as medicine can really help and you will only know that by monitoring.

  • jim snell

    This has to be the greatest knot head argument. Without rational testing one cannot resolve and control complex electronic systems nor can one a complex chemical plant such as a human body.

    These thoughtless arguments boggle one completely.

    Yes, if one tests and does nothing with the data, why by golly that probably is a waste unless Doctor looks at and analyzes periodically to verify what is going on.

    This 30 year+ type 2 who almost died from this crap, who finally learned to test properly and did so eating, exercising et all in the last 5 years has been with the excellent help of my Doctor able to stop and properly control this mess.

    Once a day testing is a farce providing little feedback to the patient and I am surpised if it is really useful to Doctor. This is like using a wind sox once a day to test the weather.

    I ended up testing 30 strips a day for a couple of months, went to cgms and then after problems resolved am back to 3 to 5 strips a day and eating to my meter and adding extra exercise if numbers too high, modifying diet choices and portion control. In addition, when to take metformin was also born out by CGMS data as well as nailing back dawn phen.

    My Doctor noted that when we started, whenever my glucose shot sub -70 and liver wa ssupposed to add glucose when intestines empty producing no glucose, liver would hammer my body glucose to 511 and slide back to 278-311. Answer was keep blood glucose from dropping sub-100. After that no bad liver dumps from that.

    Dawn Phen was so bad it was dumping out at 238 each and every morning. From caveman meter and cgms, noted that this action seemed to start at 3:00am and by adding separate 500mg metformin doses at 10:00pm and 12:00am would arrest the excess liver glucose release. Extra Insulin was not stopping.

    Watching glucose output cycles on cgms it became clear that whenever I ate a snack at end of cycle – glucose dropping, liver would decide to jump into party and hammer my blood glucose up to 511/311/278 even though finger tips at 140 thru 200. Answer – metformin up to dose during those intervals would arrest. Hence – take metformin at meal time one hour before eating meal arrested those monkeyshines(metformin up to dose strength in blood stream as intestine glucose dropping.

    Diet and exercise were also critical partners. Diet was set to 1200 calories modified low glycemic per day and exercise walking upped to 2 miles walking before dawn phen arrested and dropped back to 1.5 miles daily.

    Also walking and testing smoked out fact that when blood glucose high, extra walking of a mile or more would drop blood glucose back reliably even in times of extreme insulin resistance.

    So, if one does not test rationally, morning wakeup, midnight before bed and 2.5 hours after main meal and dose some insulin, one has no clue what the body is doing and will have no hope of keeping a type 2 diabetes under better control, diet & portion control nor how much exercise is needed.

    I worked for 40+ years in the computer , microprocessor industry and proper rational test gear and equipment and using it properly is critical to designing, running and maintaining such equipment. On the human body skipping testing and/or one strip a day is stone henge ludicrous backward thinking solving nothing. The explosion in type 2 numbers seems to be tracking this same idiotic insanity!

  • Deb

    I proved to myself the worth of self-monitoring for me when I resumed it after 2 months and discovered I was on the way to an increased A1c. By checking before and after a different meal each day I was able to get my numbers down in weeks, and when I was in the hospital my A1c had gone down from 6.8 to 6.6. I’m about to start a round of very intensive monitoring as I change my meal plan to a new, lower calorie level, and I expect to see very helpful results. I hope to create a database of foods and how they affect my glucose, and determine when my peak levels occur after meals.
    I did this a few years ago and paid for extra test strips. It was well worth the money, because the resulting meal plan carried me through a number of years of good A1cs. My only med for diabetes is metformin, which has helped my morning levels as long as I don’t overeat late in the day.
    For my husband, self-monitoring is not an option because of a fear of needles. Fortunately for him, 5 days with a CGM showed that his meal pattern is just right for him (small meals throughout the day with no spikes except when there’s a special of 2 breakfast sandwiches for the price of one), and an increase in his daily insulin will lower everything to better levels and a good A1c. Lucky duck.
    So in our household, one rule does not fit all.

  • Susann Irwin

    I gave up on self monitoring after being very diligent due to a new MD’s not looking at or caring about my numbers. My A1C jumped to 8.6%, my highest ever. I totally freaked out and went back to my self monitoring schedule (ac, HS, any night rising episode and 4:30 am when I’m first up) and reduced my A1C to 6.6% in 6 months. I agree 100% with Jim Snell, you have to keep tabs on your own body. No matter who else cares or doesn’t because your health and function depends on it. 20+ yrs with diabetes and a little tingling in my feet is my only problem and I intend to monitor dilgently and often to keep it that way.

  • laura mabie

    I find I have much better control if I test some. I do find if I find I am a little high I will alter my diet. I pay for strips myself and think it is worth it

  • Theresa

    I fear that this is going to end up with our being allowed zero test strips instead of the “generous” (obviously said with sarcasm) one per day now allowed which really tells me nothing. I am fortunate that I am in the 5-5.6 range of A1C and I want to keep it that way as long as possible. To do that, I need to have enough strips to test before and after meals in order to see what foods do not raise my glucose level too much. But I am on a fixed income and Medicare only covers 1 strip per day. I have an excellent doctor (an internist) and she has been very diligent in working with me to keep my A1C down. I was originally diagnosed by another female internist who actually diagnosed me as diabetic when I may technically have been in what the “experts” consider to be pre-diabetes. I agree with those who say there really is no such animal as pre-diabetes–you are either diabetic or not. And due to the good care from these two doctors, I am hoping to stave off any complications as long as possible. I asked to be put on Metformin because I have been reading the research that says this drug even shows some promise in staving off dementia.

    I agree with Susan and Jim. And, Susan, congrats on your diligence! I hope to be able to do the same.

  • Arlene Montgomery

    I am type 2. My doctor was not too concerned or interested in numbers. I got sloppy with diet and when I got back to testing I discovered my numbers were way above what they had been before I stopped testing. Morning, after meals, etc. all much higher than before and climbing. Now I am testing again. It is my incentive to keep to a healthy meal plan. Therefor I am for testing for type 2s.

  • winnie powell

    no one should be in charge of telling some one their method of control is wrong, or wasteful except their doctor. opinions are ones own, but if they are not positive keep them for your own use. Just having diabetes is enough to deal with without having someone telling you what you are doing is not relevant. However you cope is the right way as long as it is working.

  • Onoosh

    Well, I’m glad I self-monitored from the day of my diagnosis! Not only did self-monitoring help me adjust my diet and watch my carbohydrate intake, it gave me plenty of information about what exercise, food, pain and stress did to my glucose level.

    Most importantly, though, it helped me figure out I wasn’t a Type 2, but did, in fact, have LADA, and convinced my doctor to order the tests that confirmed it. Without self-monitoring, I would have had no idea for months that my BG was going steadily up as I continued to lose weight. And I would have been kept on inappropriate and ineffective drugs instead of going back on insulin.

    Without self-monitoring and the self-advocacy and control it allows, I’d be willing to bet a lot more cases of LADA would go undiagnosed.

  • Donna G

    Frequent testing (2-6 times a day)proved essential for me to take my recently diagnosed diabetes from an A1C of 10.5 to 6.4 in nine months without drugs, other than two Metformin pills that caused immediate detrimental side effects.

    I am one of the rare cases of immediate devastating blurred vision and racing heartbeat with what is for most people a “wonder” drug. It took more than six weeks to get those first two pills out of my system. My eyesight has returned almost to normal with the care of a vigilant eye doctor, and the firing of the general practitioner who urged me to keep taking the drug.

    With an endocrinologist monitoring my progress, lots of self-educating online, reading the best books available on my condition and trial and error testing on foods with pincushion fingers for awhile, I soon learned what I should and should not eat, how big a meal I could eat, and how fiber combinations with certain foods work. I also pinpointed that I have dawn phenomena, and that disturbed sleep patterns and stress affect my numbers badly, while meditation and exercise reduce my readings. All because of self-testing.

    I do research in my job. Self testing is, for me, essential research for any diabetes diagnosed individual willing to take responsibility for changing their lifestyle to better cope with this complicated disease. There is no one “right” way to treat diabetes. Self-testing strips are an essential tool for many of us, and should be an immediate and freely distributed option for the self-motivated who understand the value of researching how to best adjust their lifestyle in facing this disease.

  • jim snell

    Donna G: Special thanks for sharing your situation and what self testing meant to you.

    For me some well meaning folks somehow have got coupled up with the self testing is a waste of time.

    Only with rational, consistent testing can one establish what is going on with ones body and give the Doctor the detailed data that will enable him to do his best helping the patient.

    Any other story is a clamor to return to divining rods and Merlin’s magic wands and incantations and other assorted black magic!

    Best wishes and good health as well as good luck with your health!

  • Robert E.

    I monitor 3-4 times a day on average and have been for 25 years. It’s a great tool to guide my eating and my exercise. For me there is no pain in sticking my fingers, so that is not a consideration.

    It’s not logical to me that not knowing what is happening to ones blood sugar is preferable to knowing. If saving money is the idea, not monitoring is a bad place to do it and will likely result in higher cost treating the increased problems associated with unmonitored blood sugar and diabetics.

    Of course I regularly monitor my blood sugar and will continue to do so.

  • jim snell

    Robert E. Bless you and thank you for your excellent experience and feed back.

    Best wishes and continued good health.

  • jim snell

    As a niggling rude question; who are the actual technical authorities and names of their experts recommending a no test – testing is a waste of time?

    This member of the peanut gallery would dearly love to know!

  • Mary Shick

    Waiting for an A1c taken every 3-6 months to tell you your average blood sugar does not let you know what has raised your blood sugar.

    Some of us battle high morning sugars and sugars are fine at the end of the day. Some of us have morning fasting sugars at goal but sugars raise quickly after meals especially certain meals.

    I find checking 2x every other day or even once a week when sugars are stable works. Alternate the checks before breakfast and 2 hours after, or before and 2 hours after lunch or before and after exercise. This gives information on how different meals are affecting blood sugars. The before and after exercise check provides incentive to continue exercise.

    The body is constantly changing and is affected by our lifestyle interventions. It is important to check the sugar to monitor our body’s response to our lifestyle intervention and to provide positive reinforcement for our sustained lifestyle changes.

    If nothing is done with the data collected ie patients are not educated as to when to check and how to interpret or providers do not look at/interpret the data it is a waste of time and money. This route of care does not promote ownership or management of this chronic illness and in my opinion will result in accelerated progression of the complications of diabetes.

    Mary Shick

  • Debra

    My diabetes is under control at this time. I test almost every day, usually first thing in the mornings, just to keep myself in check. I think every diabetic should keep tabs on their glucose levels. How often one tests depends on the severity of the disease and how well one wants to try to keep it under control.

  • jim snell

    Amen to Debra and all those diabetics and especially type 2’s that also regularly test.

    I do now regularly after nearly rotting out. For those suggesting such a retrograde policy that testing does no good or a waste of time on type 2’s is unbelievable in this era that followed the space programs of the 70’s that is being looked at as the bygone era of science and technical progress.

  • Ron Sires

    The idea of self-monitoring as being a waste surely does not have a very severe case. My diabetes 2 comes from Agent Orange and I can tell you right off, I must monitor regularly to keep my blood glucose in check. Diet and exercise help, but that does not guarantee blood sugars are going to stay below 120.