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Self Monitoring of Blood Glucose and Type 2s

Discussion in 'Community Submitted Guides & Links' started by tubolard, Apr 7, 2009.

  1. tubolard

    tubolard · Well-Known Member

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    Please note than while this post has a lot of good basic information, as it is an older post, much of the information is now out of date, please check up to date information if you wish to read this.
    ( My thanks to Zoroaster for bringing this post to our attention )


    Sugarless Sue.
    Forum Monitor.




    What is Self Monitoring of Blood Glucose?

    Self Monitoring of Blood Glucose (SMBG) is a vital tool which those of us living with diabetes can use to improve our blood glucose management. It involves a blood glucose meter, a test strip, and a drop of blood (usually from a finger but can also be from alternate sites).

    What does it tell me?

    Simply put SMBG will identify if you are wikipedia.org/wiki/Hyperglycemia]hyperglycaemic (high BG) or wikipedia.org/wiki/Hypoglycemia]hypoglycaemic (low BG). Readings can be either in mg/dl (milligrams per decilitre) or mmol/L (millimoles per litre) (for those with an interest in this kind of thing, faqs.org/faqs/diabetes/faq/part1/section-9.html this document is a good starting point). European meters must provide a reading in mmol/L. In this document all values will be given in mmol/L.

    Meters will take a whole blood sample and report it as-is or convert it to a plasma BG reading. Plasma BG readings are higher than whole BG readings by between 12% and 15%. It is important when comparing readings that you compare alike readings, so as a rule of thumb multiply a whole BG by 1.12 to arrive at an approximate plasma BG equivalent, or divide a plasma BG reading by 1.12 to arrive at an approximate whole BG reading.

    A good way of testing whether your meter is accurate is to test a healthy non diabetic person and see if they have apparently normal blood glucose levels. Blood glucose concentrations fluctuate throughout the day. Typically levels rise after a meal and fall during fasting. Fasting blood glucose levels are relatively constant in individuals. A level of less than 6 mmol/l is considered to be normal.

    Another way of testing the accuracy of your meter is to request a control solution from your meter manufacturer.

    What should my readings be?

    Diabetes UK have published NHS recommendations diabetes.org.uk/Guide-to-diabetes/Treatment__your_health/Monitoring/Blood_glucose/Blood-glucose-target-ranges/ here, in brief:

    3.5 - 5.5mmols/l before meals
    less than 8mmols/l, 2 hours after meals. (No longer correct)

    The following information can be found on dsolve.comdsolve:

    dsolve.comdsolve also contains good information about personal targets and how to set about achieving those on dsolve.com/news-aamp-info-othermenu-60/27-how-tos/88-meter this page.

    Opinion varies about what the ideal range is, each of us should determine, with our care teams where appropriate, what is acceptable to us.

    Should I test?

    Absolutely, without a doubt - with one caveat - if you want to. You may also need to, under law, dependent on your driving status and medication regime.

    There is no doubt that achieving normal blood sugars most of the time requires a lot of personal education, self experimentation, time and effort. Whether this is worth it or not is a decision that you must make.

    Firstly, let's examine nice.org.uk/nicemedia/pdf/CG66diabetesfullguideline.pdf NICE guidelines which clearly state

    There is a catch-all phrase in recommendation 23, to assess changes in glucose control resulting from medications and lifestyle changes, odds on, if you have been newly diagnosed with type 2 diabetes then you are going to be making some serious lifestyle changes.

    At the time of posting it is believed that both Wales and Northern Ireland follow NICE guidelines.

    Appropriately for a National Health Service, Scotland has separate guidelines, in 2001 SIGN issued the sign.ac.uk/pdf/sign55.pdf]following guidelines

    And in 2005 SIGN reported that:

    In 2005 Sue Roberts, then National Clinical Director for Diabetes, produced a factsheet for SHAs on SMBG, the fact sheet reiterates NICE guidance.

    PCTs have chosen to interpret that advice and, as I understand it, a description of that interpretation can be found on page 16 of dmforum.org.uk/DMF/PDF/SueCradock.pdf]this document. One of the conditions under which it is recommended that type 2s perform a test is if we "have high blood glucose after eating". A bit cart before the horse, but the only sure way we can find out if we have high BG after eating is by testing.

    When should I test?

    First thing in the morning, before eating, one hour after eating, two hours after eating, and before bed is the gold standard. It is a question of cost, although it shouldn't be. It is very much down to you and your care team to negotiate test frequency.

    alt-support-diabetes.org]alt.support-diabetes.org has alt-support-diabetes.org/NewlyDiagnosed.htm this handy page which discusses SMBG in some detail. Phlaunt have produced a phlaunt.com/diabetes/22229807.php handy flyer which summarises the advice given on alt-support-diabetes.org.alt.support-diabetes.org.

    How should I interpret the results?

    There is a very strong link between what you eat and the resulting blood glucose levels. SMBG can help you identify what additional dietary changes you should make over and above the recommendations from your GP, DN, or Dietitian. SMBG can suggest reducing portion sizes or cutting out a specific food all together. SMBG can help you identify the impact of exercise on your blood glucose levels

    The one hour test will, on a level playing field, indicate the highest peak of BG after a meal.

    The two hour test will show what's happening after the digestive system has done its work on your last meal.

    Be aware of the pizza-effect. This is where fatty foods take longer to digest than non-fatty foods.

    dsolve.comdsolve has this to say about interpreting results:

    My GP won't prescribe test strips

    Unfortunately the NHS and many other international health care systems do not currently provide an available, affordable and appropriate educational package to help you achieve normal blood sugars. Helping you get the degree of control you want is the purpose of this post. It is essential that you become an expert in your own type of diabetes and its management.

    The first thing you must do is quote NICE guidelines and ask them to provide you with self-management education so that you can learn how to use SMBG effectively.

    If they still refuse, ask them why they are refusing.

    * If the directive has come from the PCT then make them aware of this statement from Ann Keen, Under-Secretary of State for Health in a written response to Michael Foster MP

    * If the GP asserts that testing causes anxiety and depression, suggest that the evidence used to support that little nugget came from a group of newly diagnosed type 2s and its no wonder they were anxious and/or depressed.

    * If the GP asserts that there is no evidence to suggest SMBG helps reduce BG, tell them that that is a "no sh*t sherlock" statement and that you agree SMBG on its own will not improve BG management and that there are associated lifestyle changes that can be made from interpreting the results of SMBG

    Diabetes UK's position statement on SMBG can be found diabetes.org.uk/templates/GenericContent.aspx?id=4442 here.

    My GP will prescribe test strips

    Good for you. Shout about it. Let other, less fortunate, type 2s in your area know that you have one of the good guys.

    Thanks to Sugarless Sue, Katharine, CatherineCherub, and Trinkwasser for their input to this post.
     
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  2. Patch

    Patch Type 2 · Well-Known Member

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    Maybe you could word "no sh*t sherlock" it little more tactfully. I'm sure any GP would NOT give you test strips if you displayed that type of attitude during a discussion...
     
  3. cugila

    cugila · Master

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    Hi Tubs.

    Great, informative and just what is needed for all newbies.

    Particularly like the advice about obtaining strip's etc from your GP - I think as Patch says, I too would be a 'little' bit more diplomatic, but I do get your drift though. :lol: I too have a way with words. :wink:

    Ken
     
  4. tubolard

    tubolard · Well-Known Member

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    Diplomacy was never my strong point :D, but would add that you know your GPs better than I do, so how you approach them is very much down to you.

    I think though that last decision making aid really treats us as if we were idiots - which a lot of us quite blatantly aren't.

    Tubs.
     
  5. Aadrgon

    Aadrgon · Well-Known Member

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    Thanks Tubs and all those that helped contribute to this really useful post.
     
  6. gillyh

    gillyh · Well-Known Member

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    Last time I saw the dr about my diabetes - 6 monthly mot - she told me off for using so many strips!!! She said that I should only be testing once or twice a week!! I'm type 2 on diet and exercise only but this is still not enough. what does everybody else think?
     
  7. cugila

    cugila · Master

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    Hi gillyh.
    Don't know if you read Tubs post in this thread. He puts it very clearly what the majority of us think.
    Here is the link for you:
    viewtopic.php?f=15&t=7373#p66683

    As for your nurse, tell her where to go (nicely of course). It's your body and your health. :twisted:
     
  8. gillyh

    gillyh · Well-Known Member

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    The doctor agreed with the nurse!! Cutting down on costs probably. I mentioned hypos and new foods and she still said once or twice a week. haven't tested for a wek or so now but feel fine except for a rotten cold.
     
  9. Lizz

    Lizz · Newbie

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    I have found testing first thing in the morning the most useful for me- usually over 10 - so helpful when deciding whether it will be porridge again or go mad and have a couple of weetabix!
    My gp has recently stopped prescribing the strips so I have bought some from ebay. The lancets are cheap enough and the strips 50 for about £10 - it varies a bit.
     
  10. deadwood2

    deadwood2 · Well-Known Member

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    Thanks, Tubs et al. Very useful information.

    What I really don't understand is why the GP's are so tight-fisted about strips. My nurse has chucked a cheap meter at me, along with 10 strips, and said "test once or twice a month and come back in a couple of months". She did mutter something about testing too often becoming obsessive, but most people think I'm OCD anyway :lol: I'm not sure what use it is to test something that fluctuates on at least three cycles a day, one a month. Well, I am, but it's before the watershed...

    This has to be the most difficult area; if the GP refuses outright to issue a testing kit you can challenge him about meeting NICE guidelines; if he issues a kit and insufficient consumables to make it useful, arguably he's met the guidelines if he genuinely thinks testing twice a month is adequate :roll: Then you're questioning his competence and/ or his professional judgment (SP? that looks very wrong to me) and god help you!

    But, in all the debate about SM (or BGSM as I prefer to call it) no-one has ever mentioned recording and trend analysis (or if they have, I haven't seen it, except for one valiant soul who was writing a web app).

    A single reading is useless - it's the trends your'e after - so it's break out the spreadsheet again; daily, 7,14, 28 day averages, food diary of sorts (off-plan record more like!), graphs, BMI calculator, etc. It'd cost the NHS less than £1000 to provide something like this free - and do they? Do they, pump!

    Uh oh, I'm ranting again. Sorry.

    But boy, will that nurse have some graphs to look at next time!
     
  11. Graham1441

    Graham1441 · Well-Known Member

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    Hi,
    I drive a 7.5 tonne van andwhen delivering have to take stuff up sometimes three flights of stairs so my mmol can drop fairly quickly.
    I was told i could have strips to test twice a week so i went to the PCT and complained and was toldthe PCT would contact my doctor and order him to supply more.
    Like someone said SHOUT ABOUT IT till someone hears. :D
     
  12. Romola

    Romola · Well-Known Member

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    When I went for my first appointment after being diagnose with DT2 - I was given a Freestyle test kit, which included 10 strips - but also a prescription for more test papers and needles.

    I was told to test once a day - but on a rolling program, ie before breakfast one day, 2 hours after breakfast the next etc etc. I was given a little diary to record the readings, and I am to take this back in three months, when that, along with the blood test will decide any future treatment if needed.

    Also, I wasn't told to eat a high carb diet - although a virtually non-carb diet wasn't recommended either. I was invited to go a long to the Xpert patient course - and while I was booking it up, the diabetes coordinator said that they favoured keeping an eye on the glucemic index of food.

    As I was already following a low glycemic load regime prior to diagnosis - this has meant very little difference in my eating habits - as most of the changes had already been made.

    I had a look on Netdoctor to see what readings were considered OK - and so far so good.

    I am getting round to accepting that I am not "normal" (never have been in thruth ; )) - and that desired levels for someone on T2 are a compromise - hopefully someone has done the research on what levels actually do the damage.

    Not happy to have diabetes, but very grateful that I don't have to fight battles with the medical professionals!
     
  13. tubolard

    tubolard · Well-Known Member

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    That's good news Romola, a low GI diet certainly appears to be the 'party line' as far as diet is concerned as detailed on page 9 of http://www.diabetes.nhs.uk/reading-room ... s_2008.pdf, so glad to hear that that was clearly enunciated rather than the plenty, some carbs line.

    Let us know how you get on with the X-pert course.

    Regards, Tubs.
     
  14. Janb

    Janb · Newbie

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    Thank you for the great article. My GP prescribes my testing strips for me. As a newly diagnosed type 2 I was initially having to test 5 times a day, the clinic have now reduced that, but
    I have to test before I drive and although the whole thing was stressful at first I find the testing has helped my recognise foods that I should eat as well as those I should avoid and it has helped me :p recognise the symptoms when the reading is low.

    Jan
     
  15. Graham1441

    Graham1441 · Well-Known Member

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    Hi,
    I was given enough strips to test twice a week at first, well I decided that was going to tell me nothing, so I bought my own meter and strips and tested after everything i ate.

    Now after a year and a half I KNOW what does what to me.
    I cannot see how that would cause stress, I am a lot more comfortable knowing when i have a choise i can choise knowing what the hell im doing.
    Graham.1441 :evil:
     
  16. tyroneshoelaces

    tyroneshoelaces · Active Member

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    I'm amazed that people are being told to test once or twice a week. Just on an intuitive level, one has to wonder how on earth that could help anyone. Knowing what I now know about the capricious nature of blood sugar levels, I think it's vital for many if not all diabetics to check their blood every day. I'm also amazed because I get strips whenever I ask for them, and was told to test at the very least first thing in the morning and last thing at night. I also run a fair bit, and it's crucial for me to know if my figures are slipping just before I go out. I don't think it's obsessive to want to keep a track of your readings - it seems to me to be common sense.
     
  17. Paulyem

    Paulyem · Newbie

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    Can I just say thank you for providing such an excellent and comprehensive report. I have an excellent diabetic nurse and a medical practice that so far is providing me with a meter and test strips. What I have been missing though is the detail provided in the report. I have been told to keep my readings between 4 and 7 and so far I have achieved this quite successfully but I didn't know what non diabetics readings were or the problems associated with very low readings. On occasions I have been into the low 3s. Everything provided has been absorbed. Thanks once again.

    Paulyem
     
  18. Trinkwasser

    Trinkwasser · Well-Known Member

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    AFAICR this document was started in 1998 and last revised in 2002

    http://loraldiabetes.blogspot.com/2009/ ... -test.html

    The reason you are told that testing will make you depressed is this

    http://www.bmj.com/cgi/content/abstract/335/7611/132

    as you will see the major difference is that the subjects of this paper were NOT using the meter readings to adjust their diet or anything else, which is the crucial feedback loop the meter provides

    An antidote

    http://care.diabetesjournals.org/cgi/co ... /29/8/1757
     
  19. Dobbs

    Dobbs · Well-Known Member

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    Can anybody recommend a reliable internet site for the purchasing of test-yourself strips within the UK? I know we shouldn't get into endorsements, advertising, etc, but some personal experience stories are surely OK... :roll:
     
  20. Dennis

    Dennis Type 2 · Well-Known Member

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    Hi Dobbs,

    Just for general information for yourself and anyone else interested, we do not allow commerccial advertising on the site other than by arrangement with the site owners. Most advertising is posted by spammers who claim to be diabetics, but are plainly not. There is no bar on any genuine diabetic recommending a product or company that they have found to be useful or that could be of use or interest to other members.

    The cheapest sources of test strips are Ebay sellers (but you need to check the strips are not out of date) or from Abbott, who make a range of BG monitors and will sell you the test strips at cost price if you phone them.
     
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