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How often do you test?

I guess everyone is entitled to manage their own situation as they choose. I worked in Scotland where practices give free prescriptions for testing. I still feel that If your test answers a query or question for you then it’s worthwhile but I don’t think just routinely testing is worthwhile. I appreciate many of you don’t agree.
 
Dr_Ian_Dickson said:
I guess everyone is entitled to manage their own situation as they choose. I worked in Scotland where practices give free prescriptions for testing. I still feel that If your test answers a query or question for you then it’s worthwhile but I don’t think just routinely testing is worthwhile. I appreciate many of you don’t agree.
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Maybe if you had Type 2 and were trying to avoid the complications involved you would have more interest in monitoring the situation more closely than relying on the magnanimity of your HCP's every 3, 6 or 12 months depending on where you were.
I'm still not sure that many Type 2's in Scotland get meters and strip for free as most GP's refuse to prescribe them.
 
Dr_Ian_Dickson said:
I guess everyone is entitled to manage their own situation as they choose. I worked in Scotland where practices give free prescriptions for testing. I still feel that If your test answers a query or question for you then it’s worthwhile but I don’t think just routinely testing is worthwhile. I appreciate many of you don’t agree.
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I agree that you have to learn something from testing or it is a waste of time, strips, and money. I am 4 years down the line now, no medication and mostly normal levels, but I test religiously several times every day. My reason now is because it is a great motivation factor for me. On the occasions I have relaxed I have felt far more temptation to stray. I also would not be where I am if I hadn't tested and carried on testing. I would most likely be on more and more drugs and eventually insulin. As it is I haven't had any medication from day 1.
 
Another self funder here and on Metformin only so not costing the NHS a huge amount of money. The important thing I learned through testing was how many hidden carbs are in the most inocuous of foods. A HbA1c cannot tell you that the wholemeal bread one has been advised to eat by the DSN has raised your score but a glucometer can, in almost real time. No sore fingers and no stress just a very satisfying feeling when one sees bg in a better place than it was.
 
I accept what you say but the label on the whole meal bread will tell you how much carb is on it - lot easier than testing. I encourage people to learn about GI and GL. I quickly checked this in google. It’s about 70. Sugar is 100 so it’s not much different to eating that. I often told patients a baked potato is not healthy for diabetes - it is almost like pure sugar GI 80+.
You’ve probably not read my blog. I like low carb, low GI diets. These are what most people should follow but especially with diabetes. Best Wishes and if you feel multiple testing is best for you I’m not here to tell you differently.
 
Here’s a copy of today’s blog - maybe look at the earlier ones if they are of interest.
My earlier blogs have argued that we not only want to strive for good blood glucose control but low insulin levels. Insulin while essential for controlling blood sugar has many adverse functions. (1 additional adverse function of Insulin is salt and water retention which I believe can be a contributor to high blood pressure). People in pre diabetes or newly diagnosed T2D have high insulin levels and to control blood sugar are often put onto treatments that actually increase insulin levels further. Metformin is actually the only commonly used medication that helps to lower insulin levels.
On a side but related issue it’s why, I believe, studies to lower blood sugar and improve glycemic control struggle to show reductions in death and major Cardiovascular events (heart attacks, stroke etc) - they all use medications that raise insulin levels to try and lower BG.
So why not tackle this problem by removing the root cause - carbs. Throttle back on the carb intake and if you want largely remove them to encourage your body to stop making insulin and get back to burning fats - that’s what we want and it’s what our metabolisms were designed for.
I haven’t said so already but I do believe there isn’t necessarily one diet fits all. The important thing is to keep your body lean and fit. If you achieve that with a lot of exercise and a higher carb diet great but my general impression from years of practice is that most working people can’t achieve this - myself included.
If you can go down the route of calorie restriction great but if you continue to eat a good bit of carbs within this you will still get highs and lows of blood sugar and cravings for food as your blood sugar falls. But as I say whatever works for you.
Flipping back to metformin, many people do find it causes gut upset so generally it must be started at a low dose at night eg half a tab at night and slowly titrated up. This gives the best chance of tolerating it. There are some more expensive (for the NHS) modified slow release versions which can be worth trying if the normal tabs do still cause upset.
There are many think tanks in the USA about how to live longer healthier and some of these now advocate people looking for longevity to use metformin as a longevity agent. Clearly this is not something I’m advocating but it does suggest that through lowering insulin some researchers think it will be anti-ageing.
So why am I taking a low carb diet. Simply I believe it is the best diet for me and I believe arguably the best diet for many other people with or without diabetes - but particularly for the carb intolerant 2TD patient.
So low carb diet, exercise and if you are early stages T2D or pre diabetes Metformin medication. That’s the way to go. If you haven’t tried this approach then I believe you will find it rewarding.
 
Dr_Ian_Dickson said:
I accept what you say but the label on the whole meal bread will tell you how much carb is on it - lot easier than testing. I encourage people to learn about GI and GL. I quickly checked this in google. It’s about 70. Sugar is 100 so it’s not much different to eating that. I often told patients a baked potato is not healthy for diabetes - it is almost like pure sugar GI 80+.
You’ve probably not read my blog. I like low carb, low GI diets. These are what most people should follow but especially with diabetes. Best Wishes and if you feel multiple testing is best for you I’m not here to tell you differently.
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There in lies the problem, we are all different. Without testing I would not know that I can eat all carbs from above ground vegetables, tomatoes and can even manage a few new potatoes with out spiking more then 2. but even a small amount of grains double my PP BG.
Not all carbs are created equal. So Label packaging would not have helped me.
Pre and post meal testing is in my opinion essential.
 
Dr_Ian_Dickson said:
I accept what you say but the label on the whole meal bread will tell you how much carb is on it - lot easier than testing. I encourage people to learn about GI and GL. I quickly checked this in google. It’s about 70. Sugar is 100 so it’s not much different to eating that. I often told patients a baked potato is not healthy for diabetes - it is almost like pure sugar GI 80+.
You’ve probably not read my blog. I like low carb, low GI diets. These are what most people should follow but especially with diabetes. Best Wishes and if you feel multiple testing is best for you I’m not here to tell you differently.
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My DN gave me this advice with no mention at all about counting carbohydrates or indeed lowering them. She also promoted processed food by way of 'microwavable brown rice' as a healthier option. It was her comments (at the same consultation that she gave me the diagnosis of T2) that led me to read up and eventually find this forum.
If I had taken her advice I would now be on insulin (if you care to read my signature you may see why she spoke of insulin at dx).
Thanks to the knowledge and experience of members here I was able to avoid anything more than Metformin and reduce my A1c by changes to my diet. Without learning about carbs, bg levels/ranges etc etc I would be one of those people left completely in the dark. When a qualified HCP gives you duff advice you tend to start questioning more and more of what they say.
 
Dr_Ian_Dickson said:
Testing should be like any other “investigation” - is it necessary? Why am I testing? Unless you are worried about hypo and this will only happen in T2D if you are on meds that can cause this, then little point testing for this. If you are worried a food is raising your BG it might be worth a test but as has been advised your HbA1c measured at 3 monthly intervals or longer (if well controlled) is more than adequate.
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I don't agree. The HbA1c is an average which disguises BG spikes.
 
@Dr_Ian_Dickson

I think we can agree that its all about insulin.. Have you checked out Dr Jason Fung?

However when you are here please remember that a lot of us have taken control of our own health by doing things like testing, experimenting with fasting, low carb, ketogenic eating and indulging ourselves with education about our condition. A lot of this is this is either without the help of our doctors or in complete contradiction to what they have told us we should do.
We are a well informed, up to date (probably most important) bunch.
You, according to your profile, do not have Type 2 diabetes although you have an interest in it. That's great so please learn as much as you can from us. However also please respect that some of us may know a fair bit about Diabetes of all kinds as we live with it every day. You say you are a HCP (although you also say you have retired) but please note that here you are simply another anonymous member of our forum. We have recently had a few instances of people not being who they claim to be joining up.
 
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Dr_Ian_Dickson said:
Hi, looking at the original post things seemed settled and not describing the important issues that you raise in your own case in your post. I was trying to answer the specific post not your personal situation. At the end of the day I respect your opinion on what you needed to do for your own situation. In a situation where things are settled and Hba1cs are good I stick with my opinion.
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I don't actually believe an HbA1c can truly indicate how well we are contriolling our diabetes,it;s simply giving an average over time .. Testing on a regular basis will be an actual record of whether we are managing to keep our levels stable or whether iwe are getting largish swings - and both these can well give the same average results, and I know very well which pattern I prefer to see and aim for. So for many of us regular testing will be a far more useful management tool. And since I'm feeling a bit stroppy and under the weather ttoday, I'll add that as far as i'm concerned, my HBA1c results are just a pretty number for my GP to be pleased (or otherwise :wideyed:) with. It may show where I've got to, but not how I got there....

Robbity

PS And I'm another one who actually has to pay for my meter and test strips, and since i'm an OAP on a fairly low pensi9on I can't afford to test just for the fun of it.
 
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Oh dear

You seem to have hit a “nerve” @Dr_Ian_Dickson

There is an orthodox view amongst many on this forum, and if challenged you may find you are harangued from all directions.

Please don’t let this experience put you off posting.
 
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Dr_Ian_Dickson said:
I guess everyone is entitled to manage their own situation as they choose. I worked in Scotland where practices give free prescriptions for testing. I still feel that If your test answers a query or question for you then it’s worthwhile but I don’t think just routinely testing is worthwhile. I appreciate many of you don’t agree.
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Robbity said:
I don't actually believe an HbA1c can truly indicate how well we are contriolling our diabetes,it;s simply giving an average over time .. Testing on a regular basis will be an actual record of whether we are managing to keep our levels stable or whether iwe are getting largish swings - and both these can well give the same average results, and I know very well which pattern I prefer to see and aim for. So for many of us regular testing will be a far more useful management tool. And since I'm feeling a bit stroppy and under the weather ttoday, I'll add that as far as i'm concerned, my HBA1c results are just a pretty number for my GP to be pleased (or otherwise :wideyed:) with. It may show where I've got to, but not how I got there....

Robbity

PS And I'm another one who actually has to pay for my meter and test strips, and since i'm an OAP on a fairly low pensi9on I can't afford to test just for the fun of it.
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@Robbity You took the words right out of mouth (I sound like Meatloaf). The fallacy of average has been discussed many times on the forum, and there are many research papers that agree the HbA1c is not a reliable marker for blood sugar control. It is good enough for a diagnosis, but not for future control. The best and most reliable tests are post prandial readings, which can be done easily at home with a meter, with instant results. It is variability and standard deviation that matter - all readings in a narrow band with no dangerous roller coaster swings. Sadly, the HbA1c cannot tell us how many of these swings there have been. A meter can. I really couldn't care less if I never had another HbA1c, but it keeps my nurse happy and she can fill in the tick boxes.
 
Many of the points made are very fair. I think many of you are venting strong feelings at me personally which is not really what the forum should be for. If you follow a carb counting diet and are restricting carbs to under 40gms daily I doubt you will get many serious BG spikes - but maybe I’m wrong. I accept totally that it may be spikes in BG that are more harmful than averaging out things like HbA1c but still would suggest that most of the evidence for what we are trying to achieve ie leading a full healthy active life without complications is based on studies with good HbA1c control (and other risk factors). There is no one fit for everyone. I like the low carb approach as I feel it tackles the problems of raised insulin and blood glucose directly at source. I accept many of my ex colleagues don’t support this approach and I believe good dietary advice is difficult often to obtain because most hcp’s still believe low fat is best. I may not have diabetes but do have other health complaints that I feel strongly about too.
 
Dr_Ian_Dickson said:
I think many of you are venting strong feelings at me personally which is not really what the forum should be for.
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I'm not sure this is the case. Many of us have a poor deal from our HCPs. We appreciate it isn't their fault on the whole, but the financial implications and the dietary guidelines they are expected to follow. Hardly any of we Type 2s not on insulin are prescribed meters and strips and are told very clearly there is no need to test, testing is not advisable, testing is only for those on insulin. We know this is for financial reasons, although we get told all sorts of rubbish when we ask why. Even those on insulin are often quite restricted in the number of strips they get and have to supplement them themselves. Then the NHS dietary nonsense we hear isn't worth repeating. I won't get started on statins, because we all know that "all diabetics are put on statins", or at least that is what my GP told me.

So many of us feel a tad aggrieved and possibly want to vent when an HCP arrives and admits he doesn't agree with testing either. I have been testing for 4 years, self funding a meter and strips, and also some Freestyle Libres. It costs me a small fortune, but has helped and guided me, and saved me so far from prescribed medications and expensive to treat complications, so the NHS wins. Believe me, I would not be testing if I didn't need to.

Hopefully you won't take any of personally, and I'm sure there will be many that value your input. I also hope there is a lot to for you to learn about diabetics and diabetes from reading and joining in the threads. :)
 
This thread began with a person on a low carb diet who had been testing regularly and was stable and sticking to a stable low carb diet and asking was their a purpose to continually routinely testing. I believe in this case no there is no reason to routinely test.
I then get barraged by others not in the same position, not asking the same question slating me for this specific opinion.
If you take blood glucose lowering meds - sulphonylureas are the commonest, if you’re diet is not stable very low carb, if you have a current illness ie you have a reason to self test I agree with you all - and you shouldn’t have to pay anything to do that.
Sadly I’m very misinterpreted and you guys need hcp’s to be fighting with and for you - not against you - but arguments have to be fair and rational not emotive.
I’m certainly sorry I replied at all but I think many of you do need to look at the specific question asked and not adapt it to different situations.
 
@Dr_Ian_Dickson
I think it would be more graceful of you to agree to disagree and maybe think about what we have been telling you.
We (the people with Type 2 diabetes or maybe those that have it in remission) think it is a good idea for those that want to to test regularly and when newly diagnosed it is almost essential so one can see which food types cause spikes. Maybe you aren't aware but it appears the better control we have the less tests we get so that quarterly HbA1c could easily become 6 monthly or annually and then if things start to go wrong then the consequences could be quite nasty.
Some of your statemens in this thread have been a bit condescending and I fear you have unwittingly slipped into HCP mode which many of us have found quite inflammatory .

Dr_Ian_Dickson said:
your HbA1c measured at 3 monthly intervals or longer (if well controlled) is more than adequate.
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Maybe some of us would like our healthcare to be a little more than "adequate"?
Dr_Ian_Dickson said:
at the end of the day costs the NHS money.
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Most of us self fund so we are in fact saving the NHS money by monitoring ourselves and reducing bills for medication, retinopathy and amputations.
Dr_Ian_Dickson said:
I guess everyone is entitled to manage their own situation as they choose
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Magnanimous...
Dr_Ian_Dickson said:
Sadly I’m very misinterpreted and you guys need hcp’s to be fighting with and for you - not against you - but arguments have to be fair and rational not emotive.
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I'm afraid a lot of us have realised that HCP's aren't fighting for us at all...
 
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Thank you everyone for your wide ranging views. Lots to think about. I’m still getting my test strips on the nhs due to my maternity exemption. Will make sure I stock up before that runs out. I may have to look into getting a different machine after that though.
 
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