A Little Frustrated..

Ebony,
I know you're looking for individuals answers but this might be useful
Structured Self-Monitoring of Blood Glucose Significantly Reduces A1C Levels in Poorly Controlled, Noninsulin-Treated Type 2 Diabetes
Results from the Structured Testing Program study .Feb2011 .
http://care.diabetesjournals.org/conten ... f_ipsecsha

Appropriate use of structured SMBG significantly improves glycemic control and facilitates more timely/aggressive treatment changes in noninsulin-treated type 2 diabetes without decreasing GWB

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Unfortunately there was a reply from the Swansea area which seemed to completely miss the point, just looking at prescribing, rather than strips being used for a purpose

In those treated with insulin, better HbA1c was associated with greater strip prescribing. Conversely, for those treated with OHAs, greater strip prescribing was associated with a worse HbA1c.

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http://care.diabetesjournals.org/content/34/5/e57.full
I'm hoping that there will be a reply to this in the next month or so.

Ebony…
I’m leaving here for a little holiday tonight. Taking a week out. Going to stash the computer away under the bed - if my partner doesn’t take it to work with him. If you’ve follow my thread ‘re permission in Ask a question forum’ you’ll perhaps have some understanding why.
But I saw your thread… and there’s something compulsive about these things.. And that’s why the computer goes off tonight. I just wanted to say… take it easy with your keyboard.!!!! I think I understand what you are saying but computers are like pets and gardens. We love them… well I do. You’ll be sorry if you break it.

Phoenix (you too Ebony.)
I don’t understand the articles you have posted. Please can you explain what you are trying to communicate by posting them for plebs like me.

This is what I understand by it….
I Think one is an American study and the other is English. (?) There is a lot of abbreviations… some abbs are translated in the papers (see phoenixs’ links) but others aren’t so what do they all mean.? How are these things relevant to Ebony’s question.??

What I think I hear Ebony saying is something about the fact that many people are resorting to buying their own testing strips and getting excellent results.
Excellent results…(?) (!)
1) ….So Diabetics want access to BG test strips ,
2)….and perhaps should be advised to use them

To get rid of point 2)above Amswer is from Ebony’s experience of .looking at 30-40 links via google people are not being advised to use test strips and Ebony (and I ) would like to know why.?

Back to 1) Diabetics want access to test strips because they hear on this site that self testing is empowering. (have I got that right Ebony?)

BUT Some people cant afford them. ££££££. So Ebony is asking (I think)

Why cant Diabetics get Blood Glucose testing strips FREE on prescription?

The answer:to this question in relation t o Phoenix’s evidence/post (as I see it) IS:

funding for testing strips is reliant on research carried out on people who have diabetes and use BG Test strips

But theres a big problem: people with diabetes cant get BG Test strips because doctors wont prescribe (Health care practice budget reasons? or Govt guidance? dunno) So SOME individual diabetics self fund

Those who self-fund and and use Bg test strips get excellent results. (well is this true I don’t know- but Ebony believes it and I’ve certainly heard it here on this site.)

Important studies (perhaps designed to influence government and get backing for funding) exclude these (self-funded-self monitoring diabetics) from their research. Ebony is asking why?
This is or would be research that may influence access to government funding that would allow diabetics who cant otherwise afford but who want to self monitor using BG test strips because they are proactive in their health and savvy enough to understand a possible health benefit when they see one.


Conclusion… (as I see it) in relation to Phoenix’s post.
the government are never going to see the picture that funding (and by doing so allowing access) to self testing Blood glucose strips is possibly a good way toward improving life for people with diabetes.


Q..phoenix was this research done with the aim of improving the quality of life for diabetics? For Helping diabetics or governments ? To find what works or not?
…..
Q. Why the research strip testing - in your eg phoenix? What do researchers want to achieve? Are they kind of half aware that BG strip testing is becoming popular (because people are discovering health benefits.) Is it a time thing? Re a fashion thing. Is that what the thing about ‘seasons’ meant in the video clip in my thread ( re ‘permission’ in Ask a question) with Mr Gardiner. I didn’t understand it.

Ebony Keep searching and asking. I’m puzzled too. I like your style.
Sparkles.

I'm going to be a little controversial here. From the point of a type 2, I feel that the newly diagnosed need strips to find out what foods work for them and what don't. After 3 - 6 months I'm not sure what the value is of testing several times a day, surely you know what foods you can tolerate and what you can't. It's a lot of money to spend unnecessarily.

I rarely test these days and have maintained a Hba1c of low 5s for years. If my Hba1c suddenly shoots up I'll get some more strips and test but whilst everything is stable and non progressive then I don't see the point. The key is taking control of your diet, if you do that you don't need the test strips and if you don't, can't or won't I don't see what good they are going to do anyway.

For type 1s obviously strips are a necessity.

I agree and I dont check much nowadays, maybe two meals a week or something but the trick is getting your bg levels in the 5's in the first place and keeping them there and unfortunately that is harder for some than for others.

I come at this from the outside as a type 1, but one example of the benefits of BG testing for type 2 sticks in my mind.

I met a lady whose husband's control had deteriorated drastically since their GP had refused to prescribe BG strips for him. He used to be well controlled and since he hadn't been able to test he had no way of working out how to keep controlled, and his wife (I did not speak to him) was VERY worried about his health. He was beginning to develop complications already so what part of that saves the government money? :shock:

There is obviously a big difference between diet controlled diabetes and tablet controlled - sorry I don't know all the abbreviations for such things. Diet controlled have no risk of hypoglycaemia, so as Hobnoblin says, newly diagnosed people need to test to begin with until they know what works, then I would imagine it is certainly not something that needs to be done every day. But if there is a risk of going hypo with tablets, then how do you check if you are safe to drive before getting in the car? And doesn't the condition of having a driving licence include that you test before driving for someone on tablets as it does for insulin? If that is the case then surely you guys have a legal argument for needing to blood test, not just a long term health benefit one.

The GP in question who refused strips to the type 2 above, also tried to restrict the ones I had as a long standing type 1! He even asked me if I 'had to drive'!! :shock: :shock: :shock: Bearing in mind I lived in a small village with a bus every two hours - and that's good in our area - and I need the car for my business, I came close to lynching the man. He also said that there was no point in giving most people test strips because in his experience people did not self adjust their regimes on the basis of the results. I argued that I had never met anyone who did not self adjust, although I had to acknowledge that he must see more diabetic people than I could possibly have met. His reasoning was most certainly not a valid excuse because the obvious solution was not to not prescribe but to educate those people in how to self adjust so that the test strips are beneficial to them and therefore to the long term Health Service budget due to prevention of complication. Now you can take a breath and live again because there was a full stop!! :wink: Forgot the commas!

This incident happened shortly after the change in recommendations came in and when I queried it with Diabetes UK, they said that the changes were meant to do the opposite and give MINIMUM advised testing levels, not maximum that many GPs seemed to have interpreted it as. I never did look up the wording of the new advice which I imagine came from NICE, who are not very.

I rest my case.

I followed advice from members on here and tested quite aggresively for about 6mths, and it worked, I found a diet that suits me and is also quite enjoyable, ( ok so I do miss the odd spud, or biscuit ), I for one know that without the initial testing I would not have had a clue, what was happening to my body, I think it is inperative that t2s test until they reach that happy medium, I suppose I was lucky in that my Gp was happy that I was active in my controls, and did issue strips, ultimately saving them time, in the long run , by self assessing myself, i now test a couple of times a week , for peace of mind mainly

Thanks trand, this is what I am going to do, test a lot at first to find whats good for me. When I find that " Happy Medium " I will reduce to perhaps twice a week for that same peace of mind. I have already found that a half can of beans ( reduced salt and sugar ) takes me up from 5.0 to 11.5 ! So no beans . :cry:

a short peak isnt that bad as long as they dont stay high for half the day. Beans provide 1 of your 5 a day and have lots good stuff

Hi Mehdave, ( bet your fed up with me ) because of that spike, I tested again at 2pm, have come down to 7.0. Just for me you understand, this testing IS helping . 8)

A friend of mine is on beta blockers and now seems to have joined our ranks too. I was reading about beta blockers and found this...

"•If you have diabetes you need to be aware that beta-blockers may dull the warning signs of a low blood sugar level (hypo). For example, you may not develop palpitations or tremor which tend to occur as the blood sugar is going too low."
http://www.patient.co.uk/health/Beta-Blockers.htm

This could be quite worrying if doctors are stopping type 2 strip prescriptions as I'm sure there are quite a few diabetics on these tablets who drive regularly etc.

I am a coach driver and I am required by DVLA to test before and during times of driving to keep my licence so I would be well out of pocket if mine get stopped.

I have been diagnosed since last November and would never have had a clue whether I was doing any good without testing.

Just my thoughts
Angie

Gratope said:

Thanks trand, this is what I am going to do, test a lot at first to find whats good for me. When I find that " Happy Medium " I will reduce to perhaps twice a week for that same peace of mind. I have already found that a half can of beans ( reduced salt and sugar ) takes me up from 5.0 to 11.5 ! So no beans . :cry:

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As Mehdave says, a short spike will do no harm. It is inevitable that the BS will go up a bit a couple of hours after meals and so long as it comes down again and all is well before the next meal then that's fine and what nearly always happens. Testing too much after meals is a bit scary and can give a false impression of needs. You've discovered that testing is vital though, and that is just how it is. I wonder if we can convince the doctors/government policy makers how important it is.

Don't wish to be a doom monger, but I'd be concerned if my BG was going into double figures on a regular basis, no matter how short a period. Beans are definitely out for me.

Hobnoblin said:

Don't wish to be a doom monger, but I'd be concerned if my BG was going into double figures on a regular basis, no matter how short a period. Beans are definitely out for me.

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As I said, I come at it from the Type 1 perspective where the risk of hypos is much higher, so for us low double figures are not so bad. I'm sure I would not want them at all if I was on diet only, or on tablets that don't cause hypos, because then the hypo worry would not be an issue. The differences between the two types are fascinating and many, so I can only offer a little uneducated opinion for type 2 and no real advice.

Hobnoblin wroteon't wish to be a doom monger, but I'd be concerned if my BG was going into double figures on a regular basis, no matter how short a period. Beans are definitely out for me.

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Can take a new T2 with high numbers at diagnoses time to come down even with Meds
also believe Gratope has only just started to test with new meter

I was BG35ish at diagnoses took me a few weeks to come down to single Numbers
and for a while still went up to 15 the odd time

Easier if you are diagnoses when Pre diabetic not in the high numbers already

Good news ebony321 and Phoenix, comments are in

Response to Comment on: Polonsky et al. Structured Self-Monitoring of Blood Glucose Significantly Reduces A1C Levels in Poorly Controlled, Noninsulin-Treated Type 2 Diabetes: Results From the Structured Testing Program Study. Diabetes Care 2011;34:262–267
Polonsky et al

http://care.diabetesjournals.org/content/34/5/e58.full

Contains some really good responses, including:

“Although the studies referenced by Stephens et al. have received considerable attention, particularly from health care payers, it is important to recognize that several other studies, in addition to our own, have shown a benefit to SMBG use in noninsulin-treated diabetes(4–6) ” and

“studies that simply look at the frequency of test strip utilization do not really assess the value of appropriate SMBG use”.

They also identify the 3 other studies. I’ve not looked at them yet, but they may be useful.

ALSO

Home Blood Glucose Monitoring in Type 2 Diabetes
Broken health care system undermines study's impact Irl B. Hirsch, MD

http://care.diabetesjournals.org/content/34/2/527.full

The title indicates most of his concerns, but he acknowledges the benefits of the process, but he seems to be worried about the finances and extra work, and is concerned about whether WE are up to it!

He also seems to want to keep tight control of when testing should take place (presumably he isn’t concerned about ‘spikes’, which I understand are now deemed to be very damaging, or whether there may be occasions when testing might allay OUR concerns).

I’m left wondering whether he, and probably thousands more, realise that ‘it’s not all about them’, or that, at least in theory, they are there for us, not the other way round.


I also came across this in my searches

Evidence Linking Hypoglycemic Events to an Increased Risk of Acute Cardiovascular Events in Patients With Type 2 Diabetes.

http://care.diabetesjournals.org/content/34/5/1164.full

Surely this is one of the potential critical consequences we who want to self monitor wish to avoid?

It looks as though the links will have to be cut and pasted.

I really do appreciate you having brought this issue to light, because I have just started the process of trying to obtain testing strips etc. on prescription. Let’s hope these studies will help.

Pac

When I was first diagnosed . years ago everyone in my area anyho was issued with a free meter and est strips and given a little book in which to recorc the results.
We were told to test first thing in the morning , just before lunch and and 2 hours aftwer an evening meal. We had o take the litle book with us when attending reviews but were old to contact the surgery if our levels were consistently over !0. The figures were needed so that the Dr could work out medication dosage etc. It was never even hinted that you, the patient could influence this process in any way.
At least that was my experience. I sometimes wonder now if that might have been because dietary advice was not considered necessary for me {except for an almost hilarious hand-out sheet}

When levels were considered saisfactory patients were allowed to reduce the testing o 3 times per week. but I never reached that happy place!

Because i had major issues with metformin which affected my coordination etc the mechanics of testing took all my concentration and I never even considered that it might do anything for me
except frighten me until I completed a DUK survey about testing asking what action I took if I had high levels. I asked he Nurse about this and she told me that was only meanyt for insulin users!

After a year or so I queried the esing frequency and was told by my Gp to test only the week prior to seeing him about my 3 monthly HBA1C resullts or if i was ill .

This worked well enough and i didn't enquire any further because I had enough to do as most medications take some getting used to for me and nothing seemed to work very well anyway.

My esting and recording however enabled me to pinpoint exactly when my levels fell overnight and his coincided with a uge retinal bleed.

A couple of years down the line and I had been forced to change my GP. If anything my levels were rising due to stress as i was geting no help from my preent practice.

Eventually my consultan opthamologist arrangedfor me to be seen by the hospital diabetic dept.
I tested my blood 3 times daily before my initial appointment as i thought it would provide a starting point for the Dr. It became apparent that I was "spiking" when eating a smaller than usual meal in the evenings.

As a result i was prescribed Januvia. I was also asked if I wanted to speak to a dietitian for the first time since diagnosis.{I wa not overweight} She was wonderful and explained about "liver dumping" which she thought explained the spike. She approved my diet and mentioned that I was wise to avaoid too many carbs- something I had always done natyrally. She also confirmed hat glimepirides did cause weight gain which Drs had always denied .

The sitaglipin worked very well for me and i started testing more o check on this.
Then by acciden i discovered his site.

I immediately began to test my reactions to various foods. This together with the januvia and
slightly increased exercise had an immmediate effect. When I saw the Diabeteds Consultab he was delighted with my results and said if it coninued i could drop the glimepirides completely which i have now done.

I am continuing to test more often because of my macular oedema. I wish to avoid the highs and lows and to keep my levels as even as possible.

I have not been denied test strips yet but am fully aware that the youngest doctors in my practice have been taught the dogma that tesing is unnecessary even harmful for T"s. I don't push the issue
and only ask for one box of 50 per monh. I use more bu buy the others myself.

I don't think it is common locally for anyone to buy strips as pharmacists have been horrified and can't understand why I don't ask the dr for more, I am very aware that others can't get any strips and i really cannot understand how anyone can deny them to T£s so I am happy to get some on rprescription although , as a pensioner it is sometimes a struggle o afford them.

If I were o be denied any at all I would pursue the matter but in the meantime I prefer not to rock the boat. Life is hard enough.
I recently received a free Bayer conour meer. I was delighted with it and would dearly love to ask the paractice o change my prexecription but daren't bring attention to the matter.

At its worst my HBAIC was 11. That was shortly after diagnosis . After that my best was ^.9 .
after that it stayed in the *'s fr a long time. Last summer , because I was not able to exercise it went to *@".

After managing to conrol things a little and starting the sitagliptin it reduced to &.2 and the last was 6'5 so yes, for me esing has been very successful. I have not changed my diet much but know far more about how things affect me . It is all a mater of balance - medication , exercise die and i is essential to know how all these things affect you. Testing is the only way to find out.

The HBA1c should be the one for the professionalds. Self testing should be for the individual if hey want to do it . I think the NHS should be able to question usage and results but blanket bans abnd refusals should not be allowed.

Unbeliever said:
"as a pensioner it is sometimes a struggle o afford them."

I thought you got free prescriptions automatically once you turn sixty. Or am I wrong? I know the box is there on the back of the prescription form for you to tick. Not means tested, I'm pretty certain. Have a look at it, I'm sure you shouldn't be paying.

Margi
Yes he will get free prescriptions as a diabetic on meds
However still has to be prescribed them to receive them he is only prescribed 50 a month
any more he pays for them not wishing to rock the boat


Unbeliever

Well said good post

I meant the extra strips I buy over and above those prescribed.