Nurse says not to test

[delphi]

Husband diagnosed in January. The forum has been incredibly helpful and the 'my fitness pal' app a fantastic resource ( they've just updated that app to count sodium and sugar ).

Anyway, I"ve not seen elsewhere on the forum so others may like to comment. Husband had his first appt with the diabetic nurse at his GP surgery and impressed with the healthcare available. All is well and gradual weight loss is working.

HOWEVER, When it came to BG testing ( we were testing before dinner / 2 hours after dinner and in the morning ), the nurse recommended he didn't - because pricking your fingers that many times would be more likely to bring on digital neuropathy. We fully understand the 3 month test is the relevant baseline, but we were finding the within-day tests useful. Anyone come across this one before ?

 

[JIS]

Hello Delphi
I am only a newbie so cannot speak from real experience. However, what I will say is that, when I had my first appointment with the Diabetic Nurse, she basically gave me diet and exercise advice and did not think it necessary that I check my BG levels. However, when pressed she did hand me a monitor and told me that I would have to read the instructions (too busy to show me).
Here I am on my 4th day and I am taking regular test and find it ESSENTIAL to having a view on how my body reacts to different foods. To be honest, if you don't check your BG levels, you are surely flying blind?
Wishing you well
John

 

[lucylocket61]

because pricking your fingers that many times would be more likely to bring on digital neuropathy.

Thats what my Diabetes Nurse said to me. I couldnt see how pricking my finger would have that effect though. I mean, I prick different fingers at different times, in different places.

Does anyone know if what the nurses said is true?

 

[samantha13]

I hope not as I prick my fingers 8+ times a day!!


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[Finzi]

That just sounds complete nonsense to me. If that were true, then all the type 1 diabetics who have to test multiple times would all have digital neuropathy. Has she seen how tiny the needles are and how little they penetrate the skin? It would certainly make sense to rotate sites and I think anybody would just do this instinctively, but neuropathy is quite a different thing. In fact, regular testing is probably the best way to *prevent* neuropathy


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[katto]

Yea totally agree it sounds like utter nonsense and I've never heard of this....would just carry on testing as much as you need and just moisturise and rotate which fingers you use.


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[ewelina]

They just want to find the way of convincing you not to test. I was told the same. Even surgery manager called me to warn that i will damage nerves in my fingers. Sorry but im very angry with my gp for not giving me enough test strips!

 

[katto]

Don't apologise...you have a right to be angry!


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[MCMLXXIII]

Mine ( not my sister in law I've mentioned previously) thought type 2 blood sugar testing was pointless and that i should wholeheartedly rely on my 6 monthly Hb1ac test.
Naturally she's a bloody fruitcake.

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[Yorksman]

By far the greatest benefit in testing is confirmation that you are eating the right foods and with that confirmation comes reassurance and confidence. That spurs you on to make even more lifestyle changes. They'd be the first to say that you had been eating all the wrong things if your 6 monthly hba1c was high and that you need to take responsibility.

 

[Emilio]

I'm a type 2 diet controlled male diabetic who returned to UK a year ago after 10 years in Spain.
6 months ago my Hb1ac test was 47 and the doctor said to go on tablets. I was not happy and was asked for another few months, which I was given. This time it was 41, and the doctor said ok, don't go on tablets at the moment, but you will have to one day, are you living a healthy lifestyle, are you walking enough? In fact I exercise hard 6/7.

I have not been offered access to a diabetic clinic, though I've had eye and foot tests.

The doctor refuses point blank to give me test strips, saying the NICE guidelines show no outcome improvement, so I have to fund my own testing. It is hard to keep my carbs down to the required level, and the only way I find I can achieve this is by regular testing. I feel totally disillusioned both by the general lack of help and the refusal to prescribe strips (I don't even get free prescriptions). I'm determined to stay off tablets.

What do people think?

 

[AMBrennan]

because pricking your fingers that many times would be more likely to bring on digital neuropathy

I suppose that it's true since trauma can cause digital neuropathy, and strictly speaking pricking your finger would be more likely to result in that than not pricking your finger.

To be honest, if you don't check your BG levels, you are surely flying blind?

No. "More likely" does not mean "absolute certainty". Do you think smoking is healthy because not every smoker instantly drops dead?

The underlying problem is that the NHS, based on the available evidence, does not consider regular testing in T2 patients to be effective. Your nurse acted accordingly, and whilst her only-technically-correct argument is not exactly laudable she did her job.

neuropathy is quite a different thing. In fact, regular testing is probably the best way to *prevent* neuropathy

Neuropathy is nerve damage which can be due to multiple causes such as diabetes but also trauma; your argument rests on the unproven assumption that regular testing improves outcomes enough to make up for the increased trauma.
[disclaimer: my arguments are usually much more subtle than you may think - I am not saying that your conclusion is wrong; however, your logic is]

if you don't check your BG levels, you are surely flying blind?

Well, yes, but that doesn't really matter since you ultimately don't care about having a neat record of your BG levels but about real-world outcomes. The crucial question is whether or not regular BG testing resting in tangible real world outcomes.

Your argument from theory is plausible, but that is no longer considered sufficient since we practise evidence based medicine. Simply out, we have painfully learned over time that, in medicine, quite frequently plausible theories just don't always result in the expected outcome.

It is hard to keep my carbs down to the required level, and the only way I find I can achieve this is by regular testing.

Sorry, but what does one thing have to do with the other?

I'm determined to stay off tablets.

T2 diabetes is a medical condition where the body does not work the way it should. Some of the medication, in particular 1st line treatment Metformin, goes some way to fix that. The evidence your doctor's prescription is based on shows that medication improves results (that is to say, when people like you were given medication then they suffered fewer adverse events compared to the group receiving no medication).

 

[Emilio]

Bearing in mind that the main determinant of BG levels is carbs intake (ok, I know there are plenty of others), I know from experience that if I stop testing for even a few days, then my BG levels will go up.

As someone else said, it is important also to see the effect of exercise (how hard, what type), and also to distinguish between particular foods, not just between carbs/fats/proteins.

 

[Squire Fulwood]

[disclaimer: my arguments are usually much more subtle than you may think .

I noticed that.