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Test Strips - Complaint Response from the Dept of Health

Fergus I agree that HCP's poor knowledge is often the problem with diabetes management and think that all people with diabetes should have access to their local diabetes specialist team. The poiht that I making is that it is totally unrealistic for the NHS to fund any costly intervention for which there is no robust evidence! Anc I am not going to say that the HbA1c has no value just because some HCP's with poor diabetes knowledge do not act correctly upon the results. The difference is that all the evidence we have says that it is the HbA1c is the gold standard if used correctly for managing this group of patients, but that there is no evidence that bg testing improves control for the specific group of patients. I really feel people are misunderstanding the point that I am trying to make hers. To try and summarise - the best way to manage the least complicated T2 diabetes on diet/metformin is to have regular HbA1c tests alongside support from knowledgeable HCP's, and that blanket bg testing has been shown to have little effect, according to the evidence! That is not to say that bg testing does not have a place and is of course useful for some with T2 diabetes on diet/metformin. My response initially was to the suggestion that all t2 diabetics should be bg testing despite there being no evidence to support this. This is not how the NHS works, not for diabetes or any other condition.
 
@katiek - your opening line contained this
the reality is that there is no robust, conclusive evidence that it improves diabetes control for those with type 2 on diet/diet and metformin
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If this isn't saying testing is pointless then I don't know what is!

I am Type 2 controlled by diet and metformin and I can say 100% that my control has only been as good as it has because I have tested and I know what affects by blood sugar and what doesn't. Without testing, I'd be completely in the dark about how well I was doing until my next HbA1c test in February.

Protein can affect BS levels through gluconeogenesis and they can have a profound effect on BS levels for people who are insulin deficient (some T2s are insulin deficient - see here: http://www.ncbi.nlm.nih.gov/pubmed/9416027 )

I'm not offended by your post but I am concerned that the attitude expressed in it could result in people who could benefit from testing not doing so and adversely affect their health

Oh, and another point in relation to this quote from your original post
if you aim for 40 to 50 grams of carbs with each meal, with maybe 10 to 20 gram carb snacks either side, this is a good basic starting point for most
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If I aimed for that, my BS would still be in the teens most of the time - I can't eat 50g of carbs in a day if I want to keep my BS levels low (and I know that because I've been testing). If I'd followed the "advice" you seem to think is the gold standard, I'd have massively high BS levels still and wouldn't know until my next HbA1c test, at which point my medication would probably be increased because no-one would know the profound effect even moderate amounts of carbs have on my system...
 
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I think the problem is that @katiek is not a diabetic, according to his/her profile page.

3months is a long time to wait to see if things are improving. After that some posters have had to wait another year before their next test and nobody likes to be in a state of limbo.
HCPs should be up from and tell people that finance is the problem rather than stupid things like it will destroy the nerves in your fingers. Uncontrolled diabetes can affect the whole nervous system! It is the excuses that HCPs use that destroys their relationship with their clients.
We know the NHS does not have a bottomless pit of money but if people are educated as to how to use test strips, and how to make changes according to their results then there would be less money spent on complications that are costing the NHS large sums of money every year.

There are people who do not want to test and will be happy to rely on results but you cannot expect proactive diabetics to be happy taking the same route.
 
Yes phil but I am not talking about those with insulin deficiency, I am talking about those on diet/metformin whose main problem is insulin resistance (around 80% of those with T2 diabetes in the early stages), which over time then leads to insulin deficiency, which then leads to the introduction of additional medications such as gliclazide (to stimulate insulin production) or injecting insulin. so I stand by my point that in the majority of those with T2 diabetes on diet/metformin protein has little effect on their diabetes, unless you eat too much, which like over conssumption of any food group will lead to weight gain and therefore increase insulin resistance.
 
As a T1, I can confirm the comments regarding the impact of protein on bg levels. If I take a whey protein shake and do not apply insulin, I see a noticeable increase in bg level with no carbs. Anyone eating in a low carb fashion will see this kind of reaction. So to say that protein has no impact on bg levels is incorrect and there is plenty of good evidence to back this up.
 
Well catherine I'm not sure that me not being diabetic means that I can't have an interest or understanding in it. Diabetes discussions are not the sole property of those with diabetes I hope you will agree! I seem to be upsetting a lot pf people here and it is not my intention! But I feel strongly about this area of medicine and about the NHS in general. But I just think you have to be realistic, regardless of if people are taught to use the strips properly if they are not required and you have a good hba1c and there is no evidence that bg testing will improve your control then I dont think they should be prescribed. Just as a rough estimate of costs if every person with diabtes in the UK was to test even once or twice a day this would be around £720,000,000 a year in strips alone. That is a totally unjustifiable cost without supporting evidence! There are not thd funds for this no matter how much people want them. As for the complications associated with high bg levels, these usually occur aftef years of uncontrolled glucose levels, not overnight. Therefore if you're hba1c is persisently high your hcp should startf with interventions, which may include bg testing! But people not being blanket prescribed test strips is absolutely not the reason that there are huge cost implications from badly managed diabetes and the associated co morbidities.
 
tim2000s said:
As a T1, I can confirm the comments regarding the impact of protein on bg levels. If I take a whey protein shake and do not apply insulin, I see a noticeable increase in bg level with no carbs. Anyone eating in a low carb fashion will see this kind of reaction. So to say that protein has no impact on bg levels is incorrect and there is plenty of good evidence to back this up.
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Tim you obviously did not read my respknse, you are T1, so you produce no insulin. I am talking about T2, which is a separate condition with separate causes, and I am talkijg about insulin resistance. Protein does indeed become a factor where there is no insulin or insulin deficiency but the vast majority of T2 initially start with insulin resistance and have adequate insulin production. So again I stand by my comment that protein has little effect on those whose problem is insulin resistance not deficiency, ie, those who are on diet and metformin!
 
I read it very clearly and didn't want to state the obvious. Someone with insulin resistance that had issues with managing glucose from carbohydrates will struggle with glucose from whatever source it is produced as one it is in the system, it is glucose. Therefore someone eating alow carb diet is likely to see a difference in their blood sugars if they are eating more protein, which is again likely, as I'm sure that many t2s following the lchf diet on here can attest to. I agree completely that for a non-diabetic it is largely a non- issue...
 
katiek said:
The carbohydrate content of foods is easily obtainable, if you aim for 40 to 50 grams of carbs with each meal, with maybe 10 to 20 gram carb snacks either side, this is a good basic starting point for most..
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That is how much carbohydrate I used to eat *before* diagnosis, and probably largely what brought on the condition. 40-50 per meal x 3 meals and a 10-20 gram snack 2x per day is 140-190g per day. That is *way* too much for many (maybe the majority) of T2 diabetics. With those numbers, I could have a bowl of "healthy" cereal with skim milk and banana for breakfast, a sandwich on a roll, green salad and crisps for lunch, pasta for dinner with starchy veg and two carby snacks! Again, how I *used* to eat, why I felt like absolute **** for so long, why I have neuropathy in my feet, etc. Thank the stars above I found this forum and the informed, intelligent people on it who explained how utterly important it is to TEST and to find out how certain foods affect ME. I am turning things around since last June. I have lost weight, cut my HbA1C from 106 to 57 and drastically reduced my neuropathy pain. I feel FAR better and am looking forward to an even better and healthier 2015! :)
 
Tim I'm sorry but I'm not sure I understand your response there. And you do not seem to understand what I am saying... you said "I take a whey protein shake and do not apply insulin, I see a noticeable increase in bg level with no carbs." So you yourself point out that you need to take insulin if you eat protein, because you do not have any insulin production, but what relevance does this have to someone who has normal insulin production?
 
Of course you can have an interest in diabetes, nobody is saying that but you will never know the apprehension that some diabetics feel whilst for the results of their HBA1c because they have not had one for a year.

You seem very text book in your replies and if you read around the forums you will see that people have their own stories to tell that do not correlate with researched articles.
Some Type 2's have had diabetes for many years prior to diagnosis and there are articles to suggest that these can be up to ten years. If you read around the forums, some people have gone to the G.P. with an unrelated complaint and suddenly been informed via the results of a blood test that they have diabetes. It is the luck of the draw as to whether we get complications and we can only minimise the risk by taking control with good individualised dietary advice and an education. I firmly believe that a meter should be part of this education.

Some Drs are enlightened and give patients dietary education and glucose monitors so it is an individual decision taken by HCPs as to whether we get meters or not.

I have been diagnosed for 11 years and test strips are on my prescription and I could have them monthly but I probably use one pot every six months unless I am on a course of prendisilone. which raises my blood sugars, for another complaint.

Diabetes is expensive. It costs the NHS £10 billion each year. But this is mainly because its complications, things like amputation, blindness, kidney failure and stroke, cost a lot of money. And the cost pressure that diabetes puts on the NHS is projected to get worse. But acting early to prevent complications developing and treating them as early as possible both limits their impact on the person’s life and saves the NHS money. There are a series of opportunities to improve care for people with diabetes while cutting costs or providing very highly cost effective care.
 
Well done, I am happy to hear that you are doing so well. I didnt comment on this for an argument, like some on here clearly want to just because i have different views, i have a vested interest in diabetes in a personal and professional capacity and i am taught to look at the evidence, not only to ensure patients recieve evidence based care but also to ensure that we still have an NHS in 10 years time, which according to current trends we won't have, at which point not getting strips on prescription will be the least of people's worries. It is the responsibility of all of us to look after the nhs and part of that means spending money only if there is evidence to support the intervention. No matter what people feel personally, healthcare has only progressed to the point it has by using robust scientific evidence, and there is no evidence that blanket bg testing for T2 on diet/metformin improves management whether people like it or not! The idea insinuated in some posts on here that hcp's are some sort of bogey men only interested in stopping people with diabetes from managing their condition properly is, to put it mildly, very silly.
 
@katiek
What I am not advocating is a blanket prescription of strips, rather for the offering of a competent package of education + enough strips to educate in correct eating habits.
what we have in some areas is a blanket ban plus LIES from theoretician HCPs (I saw how much Diabetes training my MBChB friends got!).
 
Well thank you for ypur sensible and informed reply, I probably shouldn't have taken it so personally but I did feel a little like I was under attack for simply airing my views and joining in the discussion. I said from the start that I fully understand why people want to test, but that cannot be the sole reason for blanket bg testing. And although I may not have had the awful feeling apprehension you describe - yet, I am probably genetically predisposed due to my family history - I do try to understand how people feel. I just think we have to be realistic about prescribing and that although it is essential for the management of some to bg test, it is not always a requirement.
 
@katiek
I don't think anyone on here thinks that as a non diabetic you don't have a right to come here and have a discussion there are many others here who like you have family with diabetes so please don't think that as a non diabetic your opinions carry no weight with us.
The reality of it is the majority of us on diagnosis get little better than a oh you have a chronic illness take these twice a day read this leaflet about complications and be on your way. And it's devastating news we have all gone home and cried at some point something I wouldn't wish on anyone.
Those of us who wish to manage our diabetes should have access to the tools required and to deny anyone that is wrong.
If I may enquire what's your professional interest in diabetes ?
 
@katiek,
I am sorry to have to argue with you on this.
I admit that it is only a n=1 experiment but my testing my BG and acting on my carb intake has resulted in a lack of requirement for drugs (Insulins,Saxagliptins, gliclazides) as well as a lack of need for strips NOW!
I believe this result is due to the package of education PLUS strips.
however I agree that strips alone should not be prescribed if the patient has not the education or desire to self- improve as the NHS does not have the resources to do it for him/her!
 
phil1966 said:
@katiek can you please point me to the studies that prove there is no benefit for T2s from testing regularly and eating to their meter?
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Well phil I am sorry to sorry but i will not be spending the last bits of my saturday afternoon trawling through pubmed, cochrane data bases etc to find studies that you can't be bothered to find yourself. They are there and easily available if you want to find them, although it is time consuming. I did however try to find the page on diabetes uk which states that although they advocate testing they admit there is a lack of evidence for it and this is a direct quote - "the current lack of evidence does not mean that smbg is not effective for those not treated by insulin, it just means there is NO EVIDENCE."

the link for tjis document is below.

ww.diabetes.org.uk/Documents/.../Test%20strips%202011.pdf

I use diabetes uk as they are heavily involved in diabetes research and will of course have done systematic reviews of all the available evidence, for which they admit there is none, and it saves me spending hours pulling up all the research to prove my point to you.. Of course this may change over with time with more studies, but I stand by point that currently there is no evidence.
 
But fergus you DID need to do bg testing if you were on those medications! I have said from the start that any progression to such meds requires bg testing, my posts are clearly being very misunderstood :-/
 
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