How Much (Monitoring) is Too Much? (Part 2)

Hey guys,


I went to the American Diabetes Association’s (ADA) Scientific Sessions in San Francisco this past weekend, courtesy of a Diabetes Self-Management press credential. It was fascinating. I’ll be writing about it for the next five weeks, but first to report the ADA’s view on blood glucose self-monitoring.

They had a session specially devoted to the British studies that cast doubt on self-monitoring for people with Type 2 diabetes, the ones we talked about last week (see “How Much (Monitoring) is Too Much?”) The speakers were divided about how much self-monitoring people with Type 2 should do, if any.

In the question period, I brought up the experiences that our readers shared. Basically, as Nicky and Aubrey said in their comments on last week’s post, that people should monitor a lot at the beginning. You need to learn how foods, exercise, and meds affect you.

You also need to monitor when you’re changing things, like trying some new foods, as Delebra suggested. But once you know how things are going, you don’t have to check as much unless something changes.

I also mentioned what Philips and Pilbur wrote, that self-monitoring is what has enabled them to do well. But I think the bottom line is what Beth wrote: “I am all for individualizing blood glucose monitoring schedules. I think we should check blood glucose when we need the information it supplies.”

I still think that telling people to monitor, but not what the results mean or what to do about them, doesn’t help. I wonder how many of our frequent monitoring group were taught by their educators or health-care providers and how many just picked it up for yourselves. It would be great to get some stories about your diagnosis and early introduction to self-management. How much help did you get, and was it the good kind of help?

I went to conference sessions on protein, carbs, exercise, sex (of course), communication between doctor and patient, prediabetes, and behavior change theories. So that’s what I’ll be writing about in coming weeks.

Learn more about the health and medical experts who who provide you with the cutting-edge resources, tools, news, and more on Diabetes Self-Management.
About Our Experts >>

  • tmana

    I was not referred to a CDE at time of diagnosis, just given two recipe flyers from which to follow the intersection, and pills to take. I knew in general about monitoring from The Other Half, and learned about its use in establishing Tight Control from the Accu-Chek web site (three guesses what brand my first monitor was… one will do).

  • Aubrey

    David, at the time of my diagnosis my doctor had me make an appointment with a certified diabetes educator before I left the office. I couldn’t get in to see her for two weeks. When I got home from work that night I got online and started searching for all of the information that I could find on diabetes. The next day on my way to work I bought a meter and started testing around 8 times a day, by the time I met with the CDE I had already started to gain a lot of insight into how the items that I ate were affecting my blood sugars. My CDE suggested that I only needed to test three times a day. I told her that I wanted to gain all the information that I could to help me control my diabetes and I was very comfortable testing this many times a day. The instruction that I received from my CDE on nutrition and just exactly what diabetes is and how it affects the body were greatly helpful. I value testing to the point that I have purchased, out of my own pocket, a CGMS and now have been using the information on trends to help me keep my A1c as low as possible. My A1c at diagnosis in March of 2007 was 7.1 my last two quarterly A1c’s have been 4.9. Testing frequently and now continuously has worked for me.

  • Dotti

    It’s been about 4 years and I never received any diabetic education. I was put on Metformin when my fasting kept rising. I recently began checking my blood sugars more frequently as my fasting continues to rise (even on Metformain). My objective was to see how different foods affect my level, and if I felt unusually tired or listless I thought it was a good way to see what my level was. I generally check my fasting every morning, and may check again during the day or evening based on the above information. My doctor said I was checking too much. I’m not getting information from him so how can I tell how I’m doing if I don’t check? It’s very frustrating, and I want to keep my sugar in a healthly range as long as I can, so I try small snacks at night and smaller more frequent meals during the day. I feel I’m on my own, and am looking to change doctors. I watch programs on Discovery Health to gain information about current treatment trends.

  • Bob

    I test four to six times a day for my knowledge. My doctor said to test in the morning and once after my worst meal of the day. I was sent to a dietician which was a real waste of time. The dietician was not helpful with any specific information. The Diabetic Nurse Educator was very helpful and informative. I have learn most of my information from web sites and magazines. I agree with Aubrey and her attitude. I think the is the way to go.

  • Cmom

    I’ve been a type 2 diabetic for about 5 years and I tested alot at first. It helped me to figure out what made my body do what. Now, I only test once in a while. With one exception…I live in the desert and we go on all day hikes nearly every weekend. While out there, I test almost hourly because the water intake, the heat, and the hiking all work to bring/and keep my blood sugar way down. Be sure to test very often when on hikes and outings. You don’t want to be caught on a blood sugar low in the middle of nowhere!

  • gbeck

    I’m just curious about Bob’s comment that he went to a dietitian and she was not helpful with any specific information. What did/didn’t she provide? My husband is diabetic,and he tests daily which actually just keeps him aware of where he is as far as his blood sugar. He had a physician change and the doctor asked him if he knew he had an elevated blood sugar (he didn’t as the information was never conveyed to him via the first doc.) He and I were very surprized and somewhat miffed as we could have been working on it sooner.

  • jlub

    I am not type 2, but was initally diagnosed as type 2 due to my age. I was told I had diabetes when the doc called me and gave me a metformin prescription and an appointment with the CDE and a nutritionist about 3 days before I got into his office.

    I had gestational diabetes a few years earlier, so maybe the CDE thought I knew from that what to do with my blood test results, but I didn’t (I didn’t really get much education with the GD). This time I was just given a meter to check my numbers 1 – 3 times a day and told what numbers were “good” goals. We spent a lot of time on how to use the meter itself, and no time on what to do with the results. Ditto with feet checks – I was told to check my feet daily but not what I was supposed to do if I found a problem (or even what was a problem) In defense of the CDE, I know had I asked she would have taken the time to explain, but I was too overwhelmed to even think of the questions. I learned pretty much everything I know, even about insulin adjustment from reading books and from others on online forums.

  • Ed Parma

    David, I test 3-4 times a day, especially before breakfast, around any meals I feel might cause a spike in my BG. I also like to test before and after exercise- I’m a part time group fitness intructor so I like to know I’m at least at 100 before class starts. Frequent testing for me has helped keep me in tight control, so much so that my last A1c was 4.9 – if it continues like this, my Doc might take me off the Actos and see how i do with just diet & exercise-

  • bellsnest

    When I was diagnosed I met with a Diabetes Educator the next day. She taught me how to use insulin. She was a bit helpful but I had already spend the evening before going on line and finding out things that I did not already know about diabetes. I had specific questions for her about how to incorporate all my different food allergies into the diet lists she gave to me. she could not give me any good ideas that I did not already have. I met with the dietitian later the next week. That was a TOTAL waste of my time. She was prepared to talk down to me and instruct me about the diet. She was not able to help me at all with the adjustments I needed to make! She would have been beneficial to someone who knew nothing of nutrition but that was not me. I spent a lot of time figuring out how I was going to get what I needed. Now when my doc wants me to “check-in” with the diabetes educator because I have been “non-compliant” because I have adjusted my meds myself, I go. She just goes and tells him to trust me and to be my partner and that I know what I am doing. I have lots of medical issues that complicate my life and of course have an impact on my diabetes. Since I go to a military clinic, I keep getting different doctors and most of them do not know anything about my rare blood disease. I end up teaching them. I realize that this sounds arrogant but I have found that having multiple chronic illnesses “throw” most docs. They keep wanting to treat just one part of me at a time and it just does not work.

  • Joan

    I have been a diabetic for 40 years. When I found out that I had diabetes, a RN went over most things with me. She answered all my questions that I had at that time. Today, 90% of doctors are to busy to talk and rush you out of the office. Diabetic Educators don’t understand things, here is an example: I can’t have wholewheat and milk is another thing I can’t have. It seems like I am talking to a wall. They keep trying to convince me that whole wheat is better for me, while ignoring what I am trying to tell them, what happens to me if I eat anything with wheat or milk. I understand about Military doctors, although most are gov’t contracted and have no idea what they are talking about and you do see a different doctor everytime you go in. I changed all that and see a civilian doctor now. I really have had to do so much on my own. Like subscribe to different magazines and online and other people. We must remember, that no two diabetics are the same.

  • Diana

    I am an RN CDE and I appreciate reading all your feedback about your experiences with a CDE. I’ll try to learn from them and not make the same mistakes. I have had patients tell me they quit testing because they didn’t know what to do when it is high. So, I tell everyone how to problem solve the results and ask them to “catch” their highest BG. I recommend different things depending on other factors such as medication, age, willingness to test etc.

    I have also had T2DM for over 10 years and have struggled with many of the same issues as my patients. Personally, I check my BG a minimum of twice a day. Occasionally, I test more frequently if I am having control problems. I too bought a DEXCOM Continuous glucose monitor and it is not covered by my health insurance. I find it has helped me more in identifying problem times, foods that effect my BG etc. For example, if I wake up at 110, before I leave the house for work, without eating breakfast, I am up to the 180’s. I would never have predicted that response. I like my job, imagine what might happen if I didn’t!

  • CalgaryDiabetic

    Dear David. I have found that monitoring is less useful now as the meters have become much less accurate because of the measuring time being dropped from 60 seconds to 5 seconds. I know time is money but… The old Bayer meter( dont remember the model) was always exactly 5% below the lab tests and this over several years. Now 10% to 15% error with the 5 second measuring time is the norm. So you are never sure if you are measuring a true effect or meter noise. In the beging 11 years ago I measured 5 or more times per day and discovered everything I needed to know about how to survive. Now being on insulin you have to measure at least 5 times a day. So far I am nasty side effect free. The only thing I can do is losse weight which if possible would be fantastic. If a company came out with a 60 second meter I would buy it in a flash.

  • David Spero RN

    Wow. There’s a whole textbook worth of experience in these stories. It seems like if you can find a good educator or nutritionist who will work with you, that’s great. But they’re really hard to find! And most doctors are even worse!

    For three years now, I’ve been working with health care providers on how to work more collaboratively with patients. But it’s slow going. You can see what we’re working on now at

    It’s just a good thing that we have the Web now and people can find information and support on-line. But we should be able to get it from our providers too. I really admire and appreciate you for speaking up to providers, informing yourself, and keeping on.

  • deafmack

    When I was first diagnosed 3 years ago, my doctor at that time did not see the use for a meter. Well another doctor prescribed the meter and told me to test 3 times a day but no other information. The doctor I have now but is leaving is really pro testing and changed my prescription to test 6 times a day. I really use it but it varies from 4 to 8 times a day so it averages out to about 6 times a day. By coming online and reading different magazines, I am able to use the information to know what my numbers are and what to do to have good control. I think testing blood glucose ia a vital part of having good control and testing often is really important. It gives one so much information but people need to know what the numbers are saying and then what to do with the numbers.