Mindful Glucose Monitoring

Self-monitoring of blood glucose (SMBG) has been around since 1975. Now, many people with diabetes check their glucose levels regularly. But some large studies question whether all those fingersticks really help. What do you think?


If you’re taking insulin, some self-monitoring is certainly advisable for safety reasons — to prevent lows, for example. But for people with Type 2 who are not on insulin, and even for some people with Type 1, I feel that the benefits of monitoring in the usual fashion are questionable.

I’ve observed over the years that most people check their blood glucose levels without thinking. They monitor at the same time or times every day, usually in the morning or before meals. Sometimes they record the numbers, or their meter does. Maybe they show the numbers to the doctor at appointments. He looks at them for a few seconds and then hands them back. If they’re too high, he might increase a dose or add a new medicine.

But he could have learned the same thing from a single A1C test, instead of 50 or 200 fingersticks. What do people really learn from monitoring without thinking about it?

Several studies have looked at whether SMBG is cost-effective. In a major study published in Diabetes Care, Mayer B. Davidson, MD, wrote, “In the US, a conservative estimate of the cost of SMBG is nearly $1.5 billion/year. This is a tremendous amount of money for an activity for which there is little…or no evidence for a beneficial outcome.”

Davidson went on to say that, “Simply measuring blood glucose is ineffective. In one study, increased frequency of SMBG resulted in lower A1C levels only in those who self-adjusted their insulin doses,” not in those who did not. So measuring is not enough. You have to do something about it.

Dutch doctors reviewed 12 major studies of SMBG in Type 2 diabetes and found that A1C did come down an average of 0.3% after monitoring started, for about six months. But by 12 months, the numbers had returned to baseline levels, suggesting that people did not stay with whatever lifestyle changes they had started in response to SMBG.

How could knowing your glucose numbers not help glucose control? Davidson gives three possible reasons. People receive little or no feedback on their results from professionals. Most people are not taught the self-management skills required to lower the measured glucose values.

Finally, and most important from my perspective, is that “the vast majority of patients measure their glucose level either fasting or [before meals,] rather than post-prandially [after meals.] Fasting values serve neither to educate (there is no information on the effect of meal composition or size) nor to effectively motivate.”

Additionally, the Dutch review found that SMBG had no effect on people’s diabetes satisfaction, general well-being, or health-related quality of life. This doesn’t surprise me, as fingerstick monitoring can be unpleasant.

William Polonsky, PhD, CDE, says that people with diabetes may see SMBG as “burdensome and pointless.” In my view, that is an accurate appraisal of routine monitoring. However, Polonsky says there is a better way. His team has published several papers on the “Structured Testing Program” or STeP, a trial that evaluated the effectiveness of structured blood glucose monitoring.

With structured blood glucose monitoring, people were taught to write down events that could impact their blood glucose control, such as exercise and changes in diet, along with blood glucose results from seven significant points — two hours after eating and at bedtime, for example — during the day. They were then taught, along with their health-care providers, how to interpret and identify patterns in these results to best address any issues with their diabetes control.

Structured monitoring puts you in charge of your own care. Mindless monitoring is just another job on top of all the other work diabetes puts on you.

Polonsky’s studies have shown that people using structured monitoring gained much more confidence in their diabetes care, used fewer test strips, and had lower A1C levels as well. Confidence is good for you.

I need to know what you think about these issues, because I’m writing a booklet to help people monitor smarter. Please help me out. Do you monitor your blood glucose levels at all? If you do, do you have a plan, some specific questions you are trying to answer? What have you learned? How often do you monitor and when? What has been your overall experience with SMBG? Is it worth the trouble and expense? Thanks in advance for any advice you can give.

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  • Pauline

    Type 2 here. I monitor fasting levels about twice a week for almost no good reason. I’m just back from my dr and he did look at my log and said the numbers were good.

    I’d love to read your booklet when it’s done so I can monitor with a goal. Or bag it.

  • Bob Fenton

    I know the importance of good SMBG and will continue to test. True, I am a type 2 on insulin; however, I have seen the value of good blood glucose monitoring and will continue to advocate for education about the value.

    Yes, I have seen mindless monitoring because the doctor or CDE would not educate the patient about the purpose or what can be learned by determining how the different foods affect your body. Education is the key for proper SMBG.

    I have also heard, too often, comments about. “the doctor did not cover this.” Sometimes this is true and at other times the patient has tuned them out because they don’t want to do it.

    I also know that in most studies on SMBG the participants are selected because they do not test or know the value of testing so that Medicare and the medical insurance complex can limit the number of test strips allowed for reimbursement.

    I also disagree strongly with the Editor’s note. I feel it is the right of the individual to make changes to the testing routine when the need calls for it. The doctor does not live with you and when you have higher blood glucose levels, a reason needs to be found that can assist in the management of diabetes.

    Yes, if the individual does not understand the purpose of the tests and what the readings mean, then definitely the person should talk to their doctor to find out and this would be desirable.

  • PAT

    WOW sometimes I forget to monitor. Must say sometimes it is bothersome. But on good days I monitor before breakfast and after exercise, and every now and then b4 dinner. I usually go low after working out at the gym. So i monitor. I try to remember after dinner but some how it slips my mind. Sometimes monitoring is a drag…just saying and keeping it real. I am assuming it is a thing called burn out….and I am at that stage.

  • jim snell

    You raise important points. What the studies do not relate though are the following:

    a) As long as body is mostly running and has smooth slow moving waveforms on the glucose action of bloodstream, yes, I AGREE, one does not need many fingersticks. ( and respectable A1C – sub 7.0)

    b) in my case due to liver misbehaving and very erratic BG numbers and being asked by my Doctor to limit my blood BG going sub 100, I ended up at 30 sticks a day and upgraded to cgms. At its worst; my a1c was 13.3 and I was NOT attending Roman Orges every night and eating 2500 + diet.

    c) trend monitoring of cgms far more valuable than large number of fingersticks.

    d) today I average 10 sticks a day – 4 for insulin injections and 6 for calibration of the drifting sensor. I could save a few there if my body would put out more consistent readings on hand and not cause strip wastage. i use cgms for digestion progress pattern as check to keep diet in line and watch for lows.

    the issue I see on all these studies is assumption body mostly working and glucose trends changing slowly and consistent repeatable pattern. In my case, that was not the case and took aggresive testing pattern to catch the stinker. In fact, originally, after initial extensive testing, i hoped i would be able to drop back to more sane limited testing sans cgms.

    that has not been case so far.

  • Carl Binder Jr

    I start with a regimen of the following steps upon awakening:
    1. Weight measurement.
    2. Blood glucose measurement.
    3. Pulse measurement.
    4. Blood pressure: Left & right arm each.

    I keep a log for all these and other readings throughout the day.

    I also do a blood glucose measurement 2 hours after my threee main meals:
    1. Breakfast
    2. Lunch
    3. Dinner

    I take Metformin & Glyburide twice a day in addition to using Victoza once per day.

    I hope that helps with the info you need.

  • calgarydiabetic

    Well my brother was in an old folks intensive care home and nobody checked his blood sugar so his feet rotten away from gangrene. How is that as an argument for daily testing ?

  • Anon Coward

    Why test at 2 hrs when the optimal time is 70 mins?

  • Diane Fennell

    Hi Mr. Fenton,

    Thank you for your comment. After further consideration, I have removed the Editor’s Note.

    Diane Fennell
    Web Editor

  • Kate

    This is a subject that really upsets me on several levels. I would agree that testing without thinking isn’t useful. However, testing and doing something with the information is key to controlling blood glucose levels.

    I am a T2 and I test often at various times during the day. I don’t use insulin. I do a fasting test every day and that information helps me decide what level of carbs I can have with my breakfast. I will test before and after certain meals to determine how the foods effect my glucose. I make note of that and use it for meal planning. I may test before exercise to make certain I won’t go too low (exercise can drop my glucose as much as 50 pts). I test when I feel crappy to determine if it’s glucose related or maybe just fatigue or thyroid issues.

    I pay for my own test strips because I refuse to be limited by my insurance company. I recently asked my doctor how many test strips per day she would recommend for me if I chose to use my insurance. Her answer stunned me. “I seriously doubt that the insurance company would allow you any test strips because of your excellent A1c”. Really? How do they think I got such a great A1c in the first place?

    Considering the results of these studies, I would think that an increase in education for people with diabetes is the key. Telling people that they don’t need to bother with testing is just absurd. Instead, teach them what to do with the information. Also teach them that it’s just a number and not a judgment.

    Now stepping down from my box of soap.

  • Donna C

    I’m Type II, diagnosed in 2008. At that time I started monitoring to determine how various foods affect me. I usually tested 2 hours after eating. I kept a notebook showing what foods (and how much) I had eaten and my BG reading. So I can look back and see what works for me. Once I got a handle on that, my doctor said I could test whenever I eat anything new or if I thought there might be a problem. So I sometimes go a month or so between tests. I do consider the glycemic index of foods in determining what to eat. Since my A1c stays below 6.0, this system works for me.

  • jim snell

    Donna C’s comments summarize the situation neatly and appropriatly. I do same.

  • Bonnie

    I am type 2 on oral meds only; I test upon rising, 2 hours after meals and before bed; averaging 4- 5 per day. I use this information to determine whether I can and what I should eat; e.g. I try to eat something every three hours so if my 2 hr. post meal is still around 180 I choose lower glycemic foods or delay eating the next meal. If it is over 180 I will test again before I eat to see if I can get it in the 120 – 180 range by exercising. I do feel the self monitoring is important because A1C is only an average over 90 days and doesn’t track which activities or foods help or hinder control. I use a monitor which plugs into my computer and I get daily trends, weekly and monthly reports and try my best to keep the spikes within an acceptable zone. I do modify my behavior avoiding decisions or driving if my glucose value is high.

  • Tom Hull

    Thanks for the imput. I was a mindless fingersticker. But you have made me anylize my record keeping and i am hopeful to be a bit more thoughtful about how and when I test and try to find a purpose for the numbers I put up in order to determine a better lifestyle, rather than to mail it to my Doctor every two weeks and let him worry about what I should do.
    I’ll try to keep you up on my progress.

  • Diane McK

    I’m Type II and test upon waking, before and after exercising. Because of my Asthma I also record my Peak Flow in the morning. I have found that my glucose level is much higher if I don’t drink water in the night. I always write down what I have eaten if my fasting reading is above 100. So far this method works well for me. I do take Metformin (1) at bedtime.My A1c has dropped from 13 to 6.7 at the last reading (March, 2012)

  • Margie N.

    I test twice daily, first thing in the morning before
    breakfast and in evening before supper. My doctor had previously told me I could drop to testing to just once daily. When I had my a1c test after six months of testing only once a day it had gone up. So I am truly testing for a reason and take heed to higher readings. I f a person if testing for no apparent reason that is just ludicrous. They need to have discussions with people who have gone blind, amputations, etc. I think its very important to test daily. It does keep me on track.

  • Cathy R

    I also agree with Donna C. When I was first diagnosed, and for my first year or so, I tested regularly until I had established what BG response was generally given by eating certain foods.

    Now, I usually forget to test (I’m a pretty repetitive eater) on a regular basis. I do, however, test when I’ve eaten something out of the ordinary and I want to know how it affects BG.

  • Rose

    I have Type 1 (LADA; originally misdiagnosed as Type 2 at age 56)so on daily insulin (Humalog fast-acting at every meal & Lantus in evening.) I test before every meal to know current blood glucose number/how much Humalog to take. Sometimes it’s high when I expected it to be low based on previous food/activities/how I’m feeling, and vice versa. Also test when I’m feeling very tired/dizzy/sweaty without heat or exertion… sometimes then my number is very low, sometimes very high, sometimes just right. Without testing when feeling weird, I wouldn’t know whether to grab orange juice or glucose tablets to fix low; or to drink lots of water and go for a walk to fix high.

  • Kim B

    I’m a T1 diabetic for 43 years now…. I started out with out test stips not available, grow up without test strips family could not afford, single mother after that no test strips!!! Thank Goodness finally could afford and use 6-8 tests a day….. They are NECCESSARY I agree telling any T1 diabetic not to test is absurd, T2 may not have to test as extensively but should still do it…. But this is the only way that I can tell if my blood sugar is low – I don’t have low blood sugar warning signals, I have to test to be sure… Remember that this is to let you know where you need to make adjustments to medications or food changes…
    The physician for any diabetic is there to help with adjustments and give advise, A diabetic has to be responsible for his own care with instructions from the doctor… But please check it is very important part of diabetic care to avoid complications!!

  • Lora Edwards

    You are so full of crap!!!

    I have been on both sides of monitoring in 43 years of type one brittle diabetes.

    I praise God for the ability to monitor.

    It has kept me from wrapping my car around a tree while driving with lows and keeps me out of the hospital.
    So I suggest you study actual working living diabetics in the next study.

  • PMG

    I was diagnosed with DT2 11 yrs ago and have managed to control my glucose levels through diet, exercise and oral meds to this point. I believe in the beginning, self-monitoring helped me see how certain things affected my glucose levels. I rarely self-monitor now, but I do see my dr every 3-4 months and have my HA1C tested for those appointments. I feel for the newly diagnosed, it is important for them to see how their choices affect them, but after they learn that, I think self-monitoring is a waste of money, time and discomfort- IF you see your dr regularly.

  • PMG

    Of course, my comments refer only to those with DT2, as I have no experience as a type 1. It probably is VERY important for a person with DT1 to monitor regularly, in order to calculate insulin dosing.

  • Martin

    I monitor my blood sugar every morning before breakfast. If it is higher than 150 for 3 consecutive days I increase my Lantus Solostar by 2 units. If it is below 150 for 3 consecutive daysI decrease my Lantus Solostar by 2 units.

    When I feel I am having a low blood sugar problem, I also take a reading for verification.

  • Pat Weiser

    I think if one is using insulin it is imperative to test frequently during the day. One needs to know how many units to use before meals and if anything should be adjusted before bedtime. That’s 4 fingersticks. Then if I feel ‘icky’ during the day, how low or high am I? How much should I eat or how much corrective insulin to use to feel better? I find it very necessary and valuable information.

  • Joe

    I’m type II and take long lasting insulin once a day, along with oral meds. I seldom have spikes and I *never* have significant drops. My A1c hovers around 6.9, and has for over a decade. In my opinion, close monitoring is costly, painful, and a major waste of time. I do it because it seems to makes my doctor uncomfortable if I don’t, But I’m not seeing any therapeutic value. I already understand nutrition and physiology, so there is no “learning which foods and activities affect my glucose.” Honestly, if I didn’t have good insurance coverage, I would think more than twice about doing it.

  • Jay

    Type 2. A1c every 6 months. Use meter especially after the occasional large meal (buffet), then use care and test until results normal.

  • Catherine Rustagi

    Intelligent self-monitoring is very much a key to keeping levels under control. I test in the morning (fasting), which tells me a lot — if it is high, what did I do the day before? Was it early-morning syndrome — how did I sleep? Also, if I am ill, a high ready confims the way I feel. I keep a food diary. If I eat something unusual and high carb, I will test several hours later to see what happened (and note not to do it again). I check before I go to bed — considering what I ate during the day, etc. It’s very helpful. It keeps me under control and thinking about the importance of what I eat, so that I don’t have to be on meds.

    Cathy Rustagi

  • Dale

    I have T2 diagnosed years ago. Currently on a cocktail of oral meds. In the beginning I tested in the Morning and usually before and after a meal. Would rotate the meal to test around. Now I don’t test often at all. The one thing I did learn from my testing is that when I fell run down or tired my BG will be in the “Normal” range and I need to eat something. My A1C is stable. My Drs advice “Keep the weight down and all the numbers come down”

  • Rick Lagrand

    I was monitoring weekly, morning, until my BG went up from 120’s to 140’s. Then I started twice a day: fasting A.M. and pre-dinner evenings. The latter readings were erratic occasionally surging to 160’s. My physician then prescribed Metformin. I continued monitoring twice a day and found that readings had stabilized at 130’s(A.M) and 110’s (P.M.).

    I find that daily BG monitoring is helpful for me to control my glucose AND remind me when I slip in my diet. Once a day (P.M.) is now adequate.

  • Jerry

    Type 2. Diabetic sinse 1990. Test twice a day but my doctor relies more on A1C than daily tests. We need some one to design a daily log sheet for type 2. It should cover exercise and eating habits as well as the monitoring numbers. Jerry


  • Charles E hardin Jr

    I think it’s a great tool and as with any tool there’s a time and place for it to be used. Learning to use it properly is the Key. It can help you understand and learn how your body reacts to food or the lack of, how excercise can help and the lack of excercise can be harmful. As stated earlier it’s all about what you learn and how you uses it to address your blood sugar problems. The results is base on your commitment or lack of.

  • jeanette

    Two years ago I was diagnosed as a type 2 diabetic. Since I am in my mid 80’s, that is not so surprising as diabetes is in my family. However, I test twice a day, before breakfast and 2 hours after evening meal. If I feel weak or extremely tired in the late afternoon, I will test to see if my sugar is low. Using my readings I adjust the food I have on my menu. By examining my readings and responding to the counts I have been able to bring my A1C to 6.2. With exercise and diet I hope not to have to go on insulin.

  • Gregory Schwartz

    I do a SMGB draw every 3 – 5 days in the morning as a “fasting blood glucose level”. This helps me keep an eye on my average levels. Since I can not afford to visit my endocrinologist every three months (I go about every eight months) it is important for me to have an idea of what my fasting blood glucose levels are. I average right around 100 to no higher than 125. Yesterday it was 98!!!! That’s the lowest fasting level I’ve ever had!

    I log the readings in a calendar book and my endocrinologist looks at them. My readings are consistent with my H1ac readings.

    My doctor told me, “whatever it is that you are doing….keep doing it.” I think my saving grace is that I am active. I have never had a driver license, so I walk, or ride my bike a lot.
    Also, I am not a “couch potato” and try to be as active as I can be. I think that is important.

    Gregg in Sarasota, FL

  • Thomas Maloney

    I have been on insulin for forty two years. At the start there was no BG Test for the diabetic to use, it was only from a lab test that we got any number. There was also the test strip the we urinated upon, this gave us data that was at least two hours old. I have been on a pump for the last twelve years, because I was having to many lows.
    I am now checking my BG eight to ten times a day. It is no hassle testing. The only hassle is getting that information from the meter to the computer. It seems like most of the meter makers have not heard, or don’t care, that many of their customers are using a MAC after years of problems with the Windows system. Now that I have a iPhone I will be using it to track my BG and carb and insulin intake. My fingures are still giving up blood when asked without problems.

  • Teresa

    T2 for almost 5 years, oral meds only, I never test unless I feel awful, then it’s a just a check to make sure it’s not my blood sugar. I find my A1C is more helpful because I make changes very gradually. Daily or weekly readings just frustrated me because I couldn’t make sense of them. Result: my A1C has been a stable 6.5 for over a year.

  • Pam Scorzello

    I hope the insurance company does not read your blog and decide not to cover the supplies. I am a Type I diabetic for the past 30 years. I test min of 4 times per day, 3 x pre meals to determine the proper Novalog insulin to dose for the meal, and at bedtime to judge hi or low before dosing Lantus and a snack if necessary. Other times, if feeling peculiar, I test to check to be sure of why, hi or low, and then treat. For management purposes I check at other times. I am busy, work full time, this is just not something I do to keep myself occupied. Thank God for the testing, it is not just a mindless endeavor for me.

  • John_C

    Didn’t get far into the article when the heat under my collar began to rise — I usually really appreciate this blog..

    A baron wasteland of ignorance compiled by those who are not diabetic and have never had to reverse years of damage helped along by medical professionals who simply don’t understand the complex nature of this disease and it’s many variances.

    Thought the goal was to keep blood sugar as close to a normal person as possible. A1c is just an average over a 2 or 3 month period and misses some extreme lows and highs.

    It is easy to see why the majority of
    diabetics have a very poor long-term outcome.

    David I know you have read Dr. Bernstein’s book — did you take away so little?

  • Sharon j

    I don’t mind checking my BG levels often because sometimes I may feel fine but my readings show that I am higher than I should be. I am T2 Insulin dependent. My problem with the A1C test is that on the average of about 3-4 times a week I get down into the 60’s and 70’s and usually other than those times, I am in normal range of what I should be. These averages I don’t believe reflect my true A1C. The lower numbers are going to pull down the higher ones and my A1C is within the GREAT range.

  • Don Irvin

    I disagree with your thoughts. I am almost 63 and have been dealing with diabetes since age of 13. I test 6-8 times a day before meals and 2 hours after and before bed. I test if i feel my glucose is high etc. I wear an insulin pump and when I can a CGM. My diabetes has been under great control since this regiment was started. I may read your book as I am always in search of new ideas

  • Jo Willis

    I have Type 2 diabetes. I was diagnosed 5 years ago and am on the same medication. GlipiZIDE. I am doing fine; my A1C is still around 6.

    From the beginning I have kept a log in a small notebook: the time and the reading. I also keep a log of what I have to eat for meals. Not always, but enough of the time to give me an idea of how what I ate affects my readings. It has become a habit that I automatically write down what I ate.

    I see what foods and amounts raise my readings.

    I test the first thing in the morning, eat breakfast, and about 2 hours later test. Test again 2 hours after lunch also noting if I had any snacks. And again after supper.

    You soon find out WHAT the culprit is. I have other health problems, so I try very hard to eat a balanced meal. I am 77 yrs old and have slowed down but still try to be active. I walk, garden, and enjoy three large labs and of course my heart, my husband.

    Hope this info will help others. Jo

  • jim snell


    Thank you for your excellent comments.
    I was 30+years chasing this crap to finally snag down in last 4 years with help of excellent Doctor. That said your comments touch my soul directly and I agree. Numbers of t2 diabetics would not have jumped 200 to 300 per cent if your comments were not bang on.

    thank you.

  • Steve

    Type 2 – insulin dependent.

    This is an irresponsible conclusion to draw. I do four to five sticks a day: Fasting, before lunch, before dinner and before bedtime as well as other times if I sense that I am out of bounds, either high or low. I walk 5-6 miles a day, usually after lunch and dinner. It is critical for me to know how much insulin to take (sometimes none at all) depending on what the meal will contain (carbs, protein, etc) and how much exercise I will be doing. Lastly, the pre-bedtime stick is critical as I need to be in the 145-165 range which will result in a morning fasting glucose of 85-115. To suggest that finger sticking is “had no effect on people’s diabetes satisfaction, general well-being, or health-related quality of life” is ludicrous on it’s face.

    Is it or can it be unpleasant? Yes – but I’d rather have a couple of unpleasant sticks a few times a day than to suddenly find myself a mile away from my house with a BG of 57. Yes – that has happened, before I did regular self-monitoring and learned how the whole diabetes thing works.

    I hope your booklet will paint a more appropriate picture of SMBG. Sheesh!

  • Steve

    I forgot to add my A1c has always been below 7, and the last two quarterly one are 6.4 and 6.5 respectively. Without SMBG I don’t believe I would be in such control – at least now I understand the relationship of food, exercise and insulin in a beneficial way.

  • Ward

    I have had diabetes2 for 30 years, and have monitored my glucose since meters became affordable about 20 years ago. I am 90 now, and have peripheral neuropathy in the feet. My dr looks at the feet at my insistance and comments rather casually that blood circulation seems good. As far as monitoring glucose, I do it fasting am and if the reading is high (over 110) I eat a modified breakfast (2 eggs, no bacon or toast) and make sure I ride my bike in the morning up the hill and coast back. I also may check my blood just before lunch, and it usually is back near 100. I take gluburide 1/2 of 1.25 mg pill and januvia once a day. As far as the feet are concerned, I wear specially fitted shoes with inserts that help control randomly felt foot pain. The quarterly HA1C tests are 6.8 or so.
    Any feedback you can supply will be appreciated.

  • Liz

    I monitor first thing in the morning when I have tried something new to eat as a snack before going to bed. I find a vast difference in what I should and should not snack on before bed time. I am a type 2 on no insulin or meds, just diet and exercise. I always monitor after I exercise.

  • Pamela R

    I am a T1 diabetic with blood sugar levels all over the spectrum. I test before every meal(3x per day) and again at bedtime. And yes, I grow weary of the finger pricks and the time it takes to do this 4 times a day. However, my blood sugar readings are very erratic with very high readings at times, but then very I can have dangerously low readings. I am losing some of the warning signs for the low readings and it frightens me that I might not catch one of them in time. Therefore, until a better way of testing comes around, I feel I must continue the injections. By the way, I am very grateful that I have this method to use for diabetes.I wish you the best with your research.

  • Eleanor

    Well, I tend to monitor my blood glucose 2 hours after the main meals (breakfast, lunch and dinner). I usually monitor 7 days per month and I switch which weeks each month (meaning one month maybe the 3rd week/another 1st week, etc). I find testing to be bothersome especially at work and at play.

  • Connie Stuart

    I have been type 1 for 55.5 years. When I was diagnosed there was only a monthly blood glucose (unless I was in the hospital) and Clinitest urine testing. I was fortunate when I was pregnant and worked in a clinical lab, that I could get blood glucose levels drawn if there was any question about my glucose. Shortly after that time the pumps came out and blood glucose testing became available. Today I generally check 8-10 times a day. I am still on a pump and have to keep check because I can easily drop and not realize that I’m very low especially when I’m doing cardiac rehab or riding my stationary bike at home. I am so thankful for the home glucose testing.

  • Will Ryan

    I periodically run seminars for those with diabetes and one of the stories I tell is how I asked those who didn’t test to raise their hands. Next, I asked one of those with a raised hand if they’d be willing to be part of an experiment. When they agree, I tell them I’ve brought a blindfold that we’ll use to cover their eyes. Then we lead them to the parking lot where we watch them drive their car. Sounds nuts, but it makes the point that without BG awareness, we’re functioning in the blind. Oh, I’ve never actually done this experiment, but I like the analogy and people seem to get it.

    At a seminar last fall one attendee told me she didn’t test. When asked why, she said that if she found out her BG was high it would ruin her day. I can relate; however this led to a discussion about not knowing if one’s BG was low, along with the consequences. This convinced her and she committed to testing four times per day.

    I’m an insulin dependent Type 2, thus testing is critical to my achieving self-care mastery. For those on oral meds, I agree that less finger sticks are appropriate when relying on the A1C to gage the effectiveness of diabetes management.

  • Kim

    I find your article misleading and dangerous, especially for Type 1 diabetics. Obviously, you need more education regarding diabetic treatment. The reason diabetics test before meals is because they need to adjust their insulin doses not just for the carbs they are about to consume, but also to know how much insulin is needed to bring down their current blood sugar level or perhaps that they do not need as much insulin if their blood glucose is low. Most diabetics who maintain tight control already test after meals as well. But as you may not be aware, injected insulin has a peak action time and that varies based on the insulin as well as the person taking it. Just as “normal” people also have higher postprandial blood sugar readings that come down when their insulin kicks in. Also, it is crucial before driving to know your blood glucose level for your safety as well as the safety of others. A1C is not at all sufficient to fine tune insulin dosages to keep blood sugars as close to normal as possible. You could have low blood sugars everyday and high blood sugars everyday and they average out to a normal A1C because that is all the A1C does is tell you the average of the last 2-3 months of blood sugars. It does not tell you the dangerous lows you are experiencing at night or the dangerous highs you may have just after supper. The endocrinologist uses the readings to make adjustments to carb ratios and insulin dosages based on trends he observes. Please read Dr. Bernstein’s book and educate yourself before making blanket recommendations about taking away the patient’s right to self-monitor and take charge of his own health. Those who choose to ignore or not pay attention to their blood glucose readings should not be used as examples to advocate against those who actually use those glucose readings to bolus with insulin when needed or to treat life-threatening hypoglycemia when they are not aware of their lows. Your syllogism is illogical because your premise is based on a fallacy that all patients are either lazy or ignorant of how to treat their blood glucose readings.

  • Daniel Arnold

    I stopped mindless checking six months ago. I no longer could afford the expense and I noticed the Doctors ignored the tests, my comments about the test and went totally by the A1C. So I determined if I could get information from the test, the test was good, if not. I don’t do it.

    Now I test when I feel bad to see if it is blood sugar. I noticed Fructose and alcohol test normal to high when in fact I need glucose, my body is having a low while the liver is catching up.
    I test before, every half hour during, and after exercise. I tend to suffur lows if I fail to eat right before and sometimes during exercise.

    I test an hour after I eat. It helps me with my diet. I tend to eat the neanderthal Greek diet.
    (Lots of fiber, raw food, good fat from olives, nuts, eggs, peppers, etc.) I do not eat a lot of meat. I stopped testing when getting up, it was always 107 at 5 am, 117 at 6 am, 127 at 7 am,etc. So I get up as soon as possible and take my oil cabsules then go eat a bite. Then it immediately goes to 92-119, depending on previous exercise and how well I slept.

    I hope your book has a component on diet. I am of the opinion, from my history, that high fiber, B12, D3 and fish oil and eliminate as mush processed garbage food as possible is the cure for some. In my case, new Doctor, no medication, my diet, vitamins, and exercise I am down to a 7.0 A1C and no super low or bing eating like I had with Metformin and Junovia. Yes I had an A1C of 6.4, but I gained an immense amounnt of quality of life for .6 points, and as I improve I suspect I will get the .6 points back.

    Good luck with your book. I can’t wait to read it.

  • David Spero RN

    Thank you for all these great comments. Especially to those who gave me exactly what I needed: their own stories and monitoring regimens. I don’t agree with everything, but I certainly learned, and other readers will too.

    Some of the criticism struck me as unfair. Right in paragraph two I wrote that if you’re injecting insulin more than once a day, you need to check regularly and thoughtfully.

    Some feedback:

    Calgary, I’m sorry to hear about your brother losing his feet. But I don’t think daily monitoring would have helped. They just would have gotten used to his high numbers (“Oh that’s normal for him.”) Weekly maybe. Probably even non-testers should do a fasting at least once a month.

    Regarding when to check after meals — I agree with anoncoward and studies that say 75–90 minutes after meals is usually best, but two hours isn’t bad. The main thing is that after-meal monitoring is more important than premeal, unless you are calculating insulin doses. After-meal monitoring allows you to see how different foods work on you.

    Congratulations to Donna C, Cathy R, and others who checked frequently and thoughtfully and learned what to do, and now don’t have to monitor nearly as much. (Again, they are not on insulin.)

    Some people check on waking and before dinner every day and say it helps “keep them on track.” That’s good, but I would say that varying the times you monitor — especially doing more after meal checks — would keep you on an even better track.

    John C, I don’t get your reference to Dr. Bernstein. He says that for people not using insulin (or only basal), that you need to measure many times a day for a week or so, to create a “glucose profile.” Then you can cut way back on checking. He says do another week-long profile when changing diets or medicines, or preparing for a doctor’s appointment.

    And to Ward who is riding his bike up hills at age 90, all I can say is wow. What an inspiration!

  • James c. Porter

    Am type 2 for a few yrs and have monitored ramdenly. Lost 20lbs at start but gained back 10 lbs. Last A1C was 6.6. Walk ave. of 2miles per day and general health is good for 79 yrs. Try to stay away from carbs where possible.

  • John_C

    Well David I am referring especially to those who don’t deal with diabetes that is on a level playing field. Up to 20% are not true T1 or T2 but T1.5, such as LADA or MODY. Dr. Bernstein pretty much ignores this too. With these ‘variable’ types the ‘honing in’ approach doesn’t work, but I have found that there are certain patterns that develop.

    Spent a lot of years and grief figuring it out. My doctor used to accuse me of ‘micro-managing’ my diabetes until (lots of research) I lowered my A1c from 12 to 5 and started enjoying a new life.
    Yes I am insulin dependent.

    Of course those who don’t follow a rather strict diet and life style end up in much the same situation — the scale is not level.

    Please don’t try and convince the powers to be to fund even less of the strips…. those who have discovered good control will not think kindly of you ūüôā

  • Joe

    Type 2: Original A1C was 14.6. Condition was diagnosed four years ago after passing out and sustaining three fractures and two ligament tears. I was shocked because I knew of no one in the family with diabetes. To my surprise, I found out that my great grandfather and one of his sons died from it. My aunt told me that “we didn’t talk about those things in our family.” Once again proving that knowledge of familial health issues is important. I could have been checking for the condition years ago.

    I monitor when my wife harasses me. Otherwise I do it a few times a week after I eat something I think I should avoid and/or feel shaky. For example, I tried a bagel with scallion cream cheese, tested two hours later, and swore off them. Ditto for Chinese food, except for an occassional slip. My last A1C was 6.7; I am 66.

  • kscarlett

    I used to test pretty regularly (every morning) but since I don’t usually eat any carbs for breakfast, a slightly high number won’t make much difference. If I’m starting a new med that will affect my BG, I will test a little more frequently to give my doc more information. I have no idea whatsoever to do with a high. I am not on insulin and since my diagnosis, I have had a pretty good A1c (with an occasional result higher than my doc likes but still lower than 7.0). It would be interesting to see that booklet, as well!

  • Jeanette Skalla

    I’m Type 2 on Metformin. My Dr. prescribed a medicine for neck pain. Even though not listefd as a possible side effect, just one pill and my reading shot up over 200. I tried again the next day and got the same result so quit taking and level went back down. Without monitoring, I wouldn’t have known.

  • jim snell

    Log that stinker. That is exactly the response I see on some antibiotics as the drug completely shuts down the met and turns liver loose – amok.

    And worse , these details are not known by doctors and med interaction lists as well.

    I found this lasting about 6 hours and when next new charge of met up to strength liver back under control as long as drug not present.

    I believe msg, some antibiotics and some drugs all interfere with metformin liver control.

  • RBYoshioka

    Hello: Quite a long list of comments here. Finally retired. My story: Diagnosed with Type 2 Diabetes approximately 30 years ago. Immediately lost 45 lbs. (slowly – 1/2 lb. per month) as per Dr.’s suggestion. Weight loss accomplished in first eight years and has NOT returned since then. Off and on in denial. Run the full range of testing programs from pre-post all meals and at bedtime to not testing for months. Went from strictly diet/exercise to diet/exercise plus Metformin and Januvia presently. Change in clinical condition attributable to general aging and semi-sedentary life, plus fluctuating stress levels and diet. Like so many here, my Dr. seems clueless regarding all of the data I collect and then share with him. I have, therefore, moved on and while I do take A1C every 6 months, I tend to rely on my own BG readings as well as my food diary that also includes information about level of activity and travel/work. One variable that I do not see addressed here is the following: I am on a course of testosterone supplementation via topically applied gel. I feel better and my readings are more normalized as well, plus, my hair had darkened significantly and I have more vigor. Testosterone levels monitored every 6 months. PSA reading (another relatively benign but mostly useless test) well within the range of normal and have not gone up (or down, for that matter) since beginning testosterone supplementation. One other thing…most resources caution against eating grapefruit because, they say, there is something in the grapefruit that makes the oral medications more effective…so why not study that particular finding and maybe incorporate grapefruit into one’s diet with a reduction in meds when eating? Just a thought…I love grapefruit and so monitor my BG and can see changes…Again, Dr. is clueless. He oftentimes tells me to go and do research for him to review…which I am happy to do, on the other hand I don’t really feel I should have to pay him for his services, but what the hell. He is agreeable when it comes to writing prescriptions so I have not many complaints. I find that stress is a major factor in my BG readings. Wish folks would take a more holistic approach to this condition – prefer not to call it a disease…but rather a metabolic condition that is amenable to modification and change. Very interesting website and blog. Keep up the good work. Mayhap come back to visit from time to time…drop a line if the spirit moves you. Best, RBYoshioka

  • sharon

    I would have to contradict your evaluation of BLS monitoring. I am type 1 and am a liable diabetic. My body is very sensitive to all the insulin and food I consume.
    A variety of factors make a type 1 diabetic walk the tight rope daily.
    Food: Type, portion, carbs, protein, fiber, all factors whether I consume too little or too much.
    Insulin: Type, timing, sliding scale amount of insulin, forgetting to take my insulin, accidently taking the short instead of the long acting or long rather than short, etc.; all the factors affect my BSL. It happens, not often thank the Lord, but I am human.
    Exercise: Too much without enough food to cover the activity is a recipe for disaster. Too little adds weight and puts our bodies into jeopardy with diabetic complication.
    Additional medications: My body has a great sensitivity too all medication. One of the more recent medications that I was prescribed while ill was prednisone. What a horrible experience. For 3 weeks my blood sugars exploded to the numbers of 600 and above just eating what was my normal diet. I had to monitor every 2 hours for that period of time to keep from having dangerously high or reaching a unconscious state while adjusting. That is on my “NEVER TAKE THAT AGAIN” list.
    If you walk in my shoes you would not say so casually that finger sticks are not necessary.

  • Bob

    I have been on a program of self determining the amount of insulin (Aspart) that I take before meals. I have been on this program for about two years now. I am a type 2 with family history of diabetes. I have started a more controlled intake of the proper foods and I have seen a marked change in my A1C readings. I do test before each meal to determine the amount of insulin to inject. For me this has given me more confidence in controlling my diabetes.

  • Laura Daher

    I’m a Type 2, diagnosed in 2001. I’m currently on Metformin and Januvia and I check 8 – 10 times per day. My A1C has gone from 7.6 (infrequent testing) to 6.0. While I agree with the author that “mindless” checking is worthless, this article really infuriates me! It seems to imply that all diabetics fall into this category! Well not this lady! I know my numbers and use them to make good meal choices.

    Why do so many fall into the “mindless checking” category? I believe it is because they are not educated about this disease and how to use their readings to manage their diets; and this article does nothing to promote changes in diabetes education, it just “gives up” on the current situation. Diabetes is running rampant in this country along with a rise in diabetes related health issues / complications. This is a progressive disease and left unchecked has some pretty devastating consequences, including death. We should be promoting more / better education, not only for diabetics, but for everyone – including doctors & DCEs, and yes, the insurance industry!

    I believe that part of being educated includes knowing your numbers (and not just an A1C taken a few times per year). How can you possibly make good choices if you do not know your pre-meal number? How can you decide if your meal choice truly was a good one if you do not know your post-meal number? Did the meal raise you up 20 pts? 30? 50? Knowing your numbers is essential for anyone who is trying to control this disease!

    My parents are a perfect example of “mindless, uneducated” checking. They are also T2 and even though they are on insulin, they are part of the “mindless” checking group(courtesy,I believe, of an “uneducated” DCE.) Oh, they check both before and after meals, but they just record the number in their logbooks and don’t pay attention to it. They don’t even adjust their insulin dosage for pre-meal highs or the amount of carbs they are about to eat – why, because they weren’t educated about USING their numbers! The DCE told them to take a certain amount of insulin (which assumes a certain number / form of carbohydrate) and that’s all they do. Some of our biggest fights are about USING their readings to make better choices when they eat.

    Both of my parents already have other diabetes related health issues and my father can go from a post-meal high of 270 to a drop overnight into the 40’s or lower – yes the rescue squad has been called on more than 1 occasion! They are the perfect example of why we need better education regarding this disease and how to use your readings. When I asked my dad why he didn’t check his reading before bed, he told me that he wasn’t told to by the doctor or the DCE. After royally “kicking butt” at that clinic, my dad was told to adjust his long-acting overnight insulin, check his number before going to bed and have a snack if needed. Suggested snack – by the DCE no less – a couple of cookies! Yeah, that’s going to help level out his blood sugar! I repeat – WE NEED BETTER EDUCATION ABOUT THIS DISEASE!

    How frequently you test is ultimately dependent upon your personal situation – obviously I think more is better, and yes, it can be a pain, inconvenient and costly. But do you really want to risk the possible consequences? And if you fall into the “mindless” checking group, PLEASE get yourself educated. If your doctor or DCE isn’t giving you the information you need, get it yourself – check out your local library, go online, attend diabetes group sessions, ASK QUESTIONS. Otherwise the author is right and you might as well stop wasting your money on test strips.

  • Barb Neal

    Long time type II. Have tested for years, 3-4x per day and ALWAYS before driving. (I wouldn’t feel like I was a responsible driver if I didn’t test before driving.) Used to test mornings and before meals, and with six insulin shots a day plus metformin still did not get good control. Now I use an insulin pump and have added post prandial checks after any meal with more than about 20g of carbs and a bedtime check, with bolus adjustments when appropriate. Since I started this regimen my A1C has been steadily below 6 despite more than halving my insulin needs–which works for me!

  • Tandi

    Type-2 since 2005. Initially I did finger-sticks 3-4 times/day for a solid 2-yrs. In that time, I had adjusted my diet & became more active & found that my readings were very stable. Therefore I became a ‘sporadic’ tester based upon if I went out to eat & over-indulged, felt feelings of ‘low’ BG, etc. Over the past 2-yrs my A1C has gone from 6.2, 5.9, 5.7 & as of June 2nd when I met w/ my Endrocrinologist, my A1C was 5.5. So I congratulate myself on doing a ‘great job’!!! I told my MD that I do not check my BG on a daily basis & she was A-OK with that, as my A1C’s continue to drop. I am on Metformin 750mg BID. Incidentally, 21-yrs ago I went diabetic during my pregnancy at age 39. I had no other risk factors other than age, as I am slim & white. At this point I am more concerned about my LDL & HDL levels. Also my BP was 111/60. I have saved $$$$ by not having to obtain lancets & test-strips as often. In fact, my yearly Rx for same often expires B-4 I need a refill. Hope this input helps you in your endeavor to put together an informational booklet on testing smarter.

  • Theresa

    I was diagnosed as a T2 on May 1, 2012. At diagnosis my BG was 405. Now I know that is high, but how high and what that number means exactly I am not sure. My blood draw was also in the morning after fasting for 12+ hours. So, it is very likely that in addition to my BG being high, I was also experiencing a morning spike. My A1C was 11.5, which I believe works out to be somewhere in the 280s. I was placed on 1000mg of metformin and 10mg glucotrol twice a day. At my last appointment my doctor started talking about Lantus again and I really do not want to have to take Lantus if I can avoid it. I am seriously overweight (morbidly obese) and have tried off an on over many years to lose weight. I do not weigh as much as at my highest point when I lost about 56 pounds (and have been able to keep it off) but I never seemed to be able to go below my weight at diagnosis. My doctor prescribed testing twice a day and at my last appointment increased it to 3 times a day, saying that any more and my insurance would not likely pay for it. So I am paying for test strips myself and testing when I wake up, before meals, 2 hours after meals and before bed. Sometimes, depending on how I feel, I may also test 60 to 90 minutes after meals as well. And if/when I wake up in the night I will also test. In doing so I have discovered that I tend to go low (57 once, 77 another time) between 2 and 3 AM and tend to be higher from 3 am on. In the last 51 days, I have learned that I have a morning spike, whether I eat immediately upon waking or not and the spike does not seem to have any relationship to what I eat. Because of frequent testing, I discovered that I appear to be very sensitive to carbohydrates so that I have been working on reducing the amount and kind of carbohydrates that I eat. As a result of the frequent testing, I am getting nearly immediate feedback as to what certain foods are doing to my body and my BG. I have lost 10-13 pounds from my weight at diagnosis. I also learned that I have mild retinopathy, which did not show up on my eye exam last year, which because it had been a while, included a dialated retinal exam. That exam showed no damage and the exam one year later showed the damage. For me testing frequently only makes sense as I learn to travel this new road that I am on. I hope that by testing frequently I will eventually get to the point where I have lost a significant amount of weight, that I will be able to have my diabetes meds cut back or eliminated and my A1C levels get into the 5-6 range. I am trying to eat to my meter, which is a somewhat new development as before I was eating to the clock. Over the years I had developed a habit of frequently skipping breakfast and/or lunch and eating my big meal of the day after work which generally was around 7 or 8 at night. Not good, not healthy. Cutting back on calories, meant eating more frequently and eating healthy snacks such as carrots, celery, broccoli, cauliflower and cucumbers. In any case, I feel that I have learned a lot in the past 51 days and that I would still be floundering were it not for frequent testing. I am a strong advocate of testing frequently and then using the results to better manage what I eat and when I eat it. I have not had a french fry since diagnosed and before diagnosis I would have fries or other fast food several times a week. Knowing what regular potatoes do to my BG has been an eye opener and thinking about my retinopathy has been a definite factor in avoiding fast food. Again, not wanting to see a meal induced spike in my BG is incentive to eat healthier. Testing frequently gives me the feedback I need to work toward getting my BG under control.

  • Laura Daher

    Reply to Theresa, posted June 20th:

    I too have morning spikes that are completely unrelated to food. It’s commonly called “Dawn Syndrome (or Phenomenom). No one seems to know exactly what causes it, although several studies appear to link it to the “stress” of getting up in the morning. Too combat this, my doctor has me taking my evening dose of Metformin just prior to going to bed. Although this hasn’t eliminated the issue, I now only spike into the 120’s instead of 160’s. It is frustrating, but since I can’t do much about it, I record my numbers and if I don’t come down by breakfast time (about 2 hours later) I eliminate almost all carbs from that meal. Usually a small can of V8 (original) and/or a small serving of fruit.

    I am also a frequent tester and use the info the adjust my meal plan when needed. Since Feb. 2011 I have lost 81 lbs – something I have had a great deal of difficulty with in the past. I worked with my doctor and a dietician to develop a plan that works for me. If you are interested, please let me know. I’ll be happy to share the meal plan with you.

  • Becky

    Type 1
    When first diagnosed, I tested after every meal for a few weeks to get an idea of how what I ate affected my BG. Because I take insulin, I test if I don’t feel “right” to check for lows. I was told to test before meals so I could adjust my insulin accordingly, but I don’t always do that, especially before breakfast. I know from experience that I am good to go in the morning so I don’t check fasting anymore. I usually check before meals if I think I might be high for some reason, but not if I think everything is okay. If I am high, I can give a correction dose. I’m pretty lucky that I have LADA and still produce some insulin of my own.

  • AndrewBaker

    As a type 2 diabetic, I self monitor on an irregular basis, but always mindful of my lifestyle activities. The pattern that I have found is that when I’ve been particularly “good”: eg – post exercise, reduced alcohol intake, low glycemic eating, (with readings being taken the morning after), my blood glucose levels are nearly always lower; though on occasion they do spike for unknown reasons.

    When I’ve “let things go” a little, the readings are higher.

    So, I use SMBG to keep me on the straight and narrow, or bring me back if I’ve wandered off. I’m a very numbers minded person, and this helps me, but I do suggest that anyone self monitoring should relate it in some way to their lifestyle to make meaningful the readings that they take: else why do it?

  • A Jackson

    I am a 68 year old white female. I was told by my doctor last week that I am diabetic. In the past, my fasting blood sugar readings were beteween 88-94. Last February, I had a reading of 101 and the doctor ordered an A1C — the results were normal. This past summer I had my gall bladder out and all the blood tests administered around the time of the surgery were normal. On December 26, 2012, I had a fasting blood test and my reading was 116. My A1C was slightly above what my doctor considered the high end of normal — 6.7. Doctor told me to take a 2mg Amaryl once a day and call back in 3 months! No information was given on any aspect of diabetes control — nothing on diet, nothing on exercise, nothing on monitoring blood gluclose. I am going to a new doctor next week, and am starting a diet from information from ADA website, but am lost as far as monitoring my blood sugar. I am not taking the Amaryl until after I see the new doctor. Don’t know if I need to have a light snack at bedtime since I am not on medication.

  • David Spero RN

    To A Jackson,

    I’m glad you’re getting a new doctor. Make a list of questions you have and either ask her or get a referral to a diabetes educator.

    Sounds like you are on a good track now, except please be careful about following ADA diet advice. They tend to recommend way more carbs than are healthy for a person with diabetes.

    The main thing, in my opinion, is to avoid starches and sugars and get more physical activity. Your numbers will fall into place.

  • Carol Taubman

    I have been monitoring every morning for several yrs. I do not take insulin. It gives me a feeling of watchfulness even tho I sometimes feel the readings are not accurate.
    I do know from this when my sleep patterns are helpful and when I am stressed. I can raise my excercise level and it helps. My main goal is to lower a1c levels to around 6.0 I characteristically run at 6.5-6.7. I test this about every 4-5 mos.
    I really appreciate your input and take your suggestions seriously.

    Thank you.( I am reasonably careful with my diet and avoid white carbs as much as possible)


  • GlennC

    A1C helps the doctor, BG testing helps the patient. I can’t make meaningful lifestyle changes from an A1C reading, just as I can’t drive my car looking out the rear window. But I can change dinner when an after-lunch reading is higher than I wanted.

    But Davidson is right that if it is a meaningless routine, it is a waste. Some will test and use the info, some won’t. We can each be do-ers and don’t-ers and different points in our lives. Factors are missing. How does a symptomless reading impact me? I don’t know until I topple over the abyss into keto or hypo or kidney or ampu or heart problems.

    To avoid the helplessness, it needs a positive spin. And I mean this quite literally, “what would you do for a Klondike Bar?”