To test or not to test...

[DiabeticGeek]

Hi People,

I am new here, and this is my first post. Indeed, I am very new to diabetes - I was diagnosed with Type II a week and a half ago, and I have yet to figure out how this is going to change my life.

So far, I have had one 10 minute appointment with a GP and a half hour chat with a nurse. Most of what I was told I already knew (although I'm not a medic I have a background in biomedical sciences, and many years ago I did research in an area that was not entirely unrelated). However, one thing that they said surprised me - they were both adamant that I should not get into self testing. The GP gave two reasons for this - one is that blood glucose levels are constantly changing, and that unless I tested "every 10 minutes" it would be impossible to get a meaningful picture, and the other was that people who test tend to record their glucose levels but not do anything about it. I am somewhat skeptical about both of these arguments, and would be very interested to hear what people think.

I thought about testing quite a lot while I was waiting for the test results (I was fairly certain that I knew what they were going to say), and I was planning to conduct a series of experiments to find what effect various combinations of foods and exercise have in order to learn to flatten the curve (which, according to my understanding is the main aim of diabetes management). Now I know that there have recently been a couple of widely publicized papers in the BMJ that suggest that testing isn't of much use. However, I can't help thinking that it would be helpful to me to know what is going on. I have changed my diet quite substantially since my diagnosis, but I have no idea what - if any - effect this has had yet and I find that kind of demoralizing. By training, and in my soul, I am a scientist - I think in terms of numbers, curves and data - and I really feel the need for some data here! I am also a geek, and I am a complete sucker for any gadgets - and I can hear the siren call of those shiny glucose meters, bristling with functionality!

So, your thoughts - should I start testing myself or not?

 

[sami]

hi diabeticgeek
yes you should test and keep testing go back to your gp and dont take no for an answer the new nice gide lines say all new diabetics should be able to test . the only resson your gp has said no is money .
you need to test so you know what food makes your bg go up and what does not as every one is diffrent . i can eat most fruits but a lot of t2's can not but if you dont test you will not no what you can eat then when you have your next Hb1Ac test the gp will wonder why its so high but if you test and use the info right it should hopefully came down

 

[brianb]

Hi
And WELCOME not that any of us want to be here. I was only diagosed as type 2 about 6 weeks ago, by sheer chance after a well being check a work. It has taken me a few weeks to actually accept that the diagnosis was correct. I was from a similar background, worked in both Biochemistry and Heamatology with a splatterering of microbiology thrown in for good measure and like you a GEEK.

I would say Yes to testing. If for no other reason then to put your mind at ease. I could not wait to go from appoiment to appointment to find my results not knowing if i was running too high and possibly causing any damage, Now that would be depressing despite whatthey say in the papers As it is with my new diet and a little exercise, mainly cycling and soon scuba diving, i have went from 16stone to 14st 10 and i have managed to keep my BG levels almost normal, with just my early morning fasting levels running at 8 ish. Thinks thats liver dump but not sure yet.

I record all my results, which is easy with te ultrasmart meter(very geeky)when im a little high i go for a brisk walk or cycle ride and it generally comes down. The lowest i have ever been is 3.9 so that is not really been a problem, i suppose if i somehow managed to get lower which is Unlikley as im not on meds I would just eat

Also with a meter you can eat different foods and check after 1 hour and then 2 hours to see what effects they have on you. I found to me GREAT suprise i can't eat bread of all things, just by itself it can double my readings never mind the filling........how can bread do that. Anyway point is everyone is different how they react to food and knowing what you can tolerate goes a long way to helping you control your BG levels.

Dont really drink as i have a liver problem(NASH) with raised ALTS, you know what that means...NO DRINK so never really had to worry about drink effecting my levels, May get hammered one weekend out of curiosity.

Anyway im sure there are others on here bursting to give advice so good luck and look forward to chatting in future.

Regards
Brian

 

[SarahK]

Hi all,

I was diagnosed with Type 2 in late March and I have also found that I can't eat bread very successfully; even the soya and linseed variety has to be restricted. I've actually cut out potatoes, rice and pasta as the wholemeal varieties have huge impact on my readings and I'd rather replace them with a load of veg that doesn't cause that to happen.

It's all fascinating stuff!!

Sarah

 

[Dennis]

Hi Brian - totally agree with you about the testing. It is absolutely vital that all diabetics should test regularly, whether you are type 1 or 2, diet controlled, meds or insulin. The only way we can know what effects different foods have on us is to try them and test the results. We all have very different metabolisms and react to foods in different ways. Unlike you, bread seems to have little effect on me, but the tiniest qualtity of pasta or rice can send me hyper.

The NICE guidelines for Type 2 say that patients should be encouraged to self-test provided they have had explained to them what they are testing for and what to do with the results. Any doctor who says that you should not test is one (or several) of the following
(a) incompetent and shouldn't be practicing
(b) too lazy to bother to explain how to interpret results and act on the findings
(c) trying to cut costs to win brownie points with the PCT (at the expense of your health)
(d) is acting on direct instructions from the PCT to reduce costs

 

[DiabeticGeek]

Any doctor who says that you should not test is one (or several) of the following
(a) incompetent and shouldn't be practicing
(b) too lazy to bother to explain how to interpret results and act on the findings
(c) trying to cut costs to win brownie points with the PCT (at the expense of your health)
(d) is acting on direct instructions from the PCT to reduce costs

Any of these are scary and depressing possibilities. I have a horrible suspicion that you are right and cost is at the heart of this. In particular, the way the nurse instantly came up with the same arguments as the GP suggests to me that she was following a "party line". However, to be charitable to them, there is some controversy about this given the recent BMJ articles. I expect that these have already been discussed here, so apologies if I am rehashing old ground, but one of them is on the efficacy of self-monitoring [responses to this] and the other on its cost-effectiveness [responses to this] - both for newly diagnosed T2. If you look at these also make sure to read the responses - they are more interesting than the articles! In short the first is saying that most people in their study (which forced them to follow a rigid year-long pro gramme of testing) ignore the results, ergo there is no benefit. The second says that testing is expensive and hence not cost-effective. In short, as far as I can see these are arguments against testing that is done badly rather than testing per se.

 

[DiabeticGeek]

The NICE guidelines for Type 2 say that patients should be encouraged to self-test provided they have had explained to them what they are testing for and what to do with the results.

Many thanks for this advice. The more I read the more I am leaning towards testing, and I shall try to use the NICE guidelines to press my GP in that direction. However, I am not optimistic about that - he seemed pretty adamant. The very first thing that he said after giving me the diagnosis - before he talked about diet or anything positive - was "whatever you do don't go out and buy a glucose meter".

One question that I do have - if I am going to go it alone, is it possible to buy strips and lancets over the counter in pharmacists without a prescription?

 

[IanD]

Find a Dr who understands - is there a diabetes support group locally who can advise? Ask chemists around the area if Drs prescribe them.

If your Dr does not recommend testing, he is not the Dr for diabetics, & you won't get proper care. See Hazey's posts.

 

[brianb]

Hi
Yes it is possible to buy strips over the counter BUT they are expensive. I have purchsed strips from online pharmacys and EBAY MUCh cheaper at about £8 to £12 for the ultrasmart strips.

The meters are cheap and you can get them online for about £10 and in the high street shops for about £15-£20 so shop around

Brian

 

[Stuboy]

Test test test!!!

Information is paramount to treating Diabetes, Type 1 or 2. How else are you going to learn how different foods and activities affect your BG????

Find a doctor who's not an idiot!!

 

[Dennis]

To DiabeticGeek,

Many thanks for providing those links. I had seen the research findings before but what surprises me is that the results were published by the research team in 2005, so why were they republished by the BMJ in March 2008? Is that a cartload of horsesh!t I can smell - oh no, its a political agenda!

I did like the response from the Aussie GP, who I thought had hit the nail very firmly on the head. The problem isn't with patients who test not acting on the results, its that the medical profession generally won't act on or believe the test results that the patients give them!

Of course the other thing that the medical profession as a whole don't like about self testing is that it inevitably reinforces what the majority of us are finding - it proves that lower carb diets reduce BS levels for most diabetics and the high-carb diets that the medical profession keeps pushing at us simply make things worse.

 

[Honey monster]

I had a very good Diabetic Nurse who was loads of help
I was testing before breakfast, 2 hours after breakfast, before lunch, 2 hours after lunch, before tea, 2 hours after tea and just before bed
I was also writing down everything i was eating for several weeks
Since my levels have become more stable I only seem to test when I'm feeling off colour or just every now and then.

 

[DiabeticGeek]

Many thanks for the advice people, I am convinced - I have bought a OT UltraSmart and started testing (and I have already discovered some interesting things). I will try to persuade my GP to prescribe strips, but for the time being I am buying them myself.

I have purchsed strips from online pharmacys and EBAY MUCh cheaper at about £8 to £12 for the ultrasmart strips.

Can anyone advise of reliable online pharmacies that sell cheap strips? I have done some googling, and all of the ones that I can find are only about a pound cheaper than Boots (add postage, and they actually work out slightly more expensive). eBay looks more promising, but as ever it is very hit or miss - you need to get lucky to get a bargain. I am also slightly concerned that buying pharmaceuticals from eBay might be a bit dodgy (one of the current sellers talks about marks on the box where the patients name has been removed - hmm...).

 

[Ozzie]

test, test , test and then an extra test for good measure.

when i was speaking to my doc, I was told to test 2 hrs after a meal. my argument against that is this.
when i first started testing, i had a bowl of porridge for breakfast with my metformin (as recommended) tested 2 hours later and my bg was 13. now to me, all that told me was my current level, it did not tell me if that level was on the way up or on the way down plus it didnt tell me how high it had gone or was going. to me that is just not enough information. so now armed with loads of strips, cost a small fortune admittedly, Im testing my self every half hour. especially after eating and in the morning. from them test have deduced the diet sheet i was given kept my sugars sky high, well too high for me anyway, so now ditched that diet and using the low carb option. my daily graph has now flatlinedish. no high peaks at all. mostly between 5.5 and 6.5. ive already posted todays results on another thread but my ultimate aim is to keep below 5.5 permantantly. once i've got all the "what i can eat" information, probs won't check that often maybe random once a week checks after eating just to make sure it's still ok. tested my self just now, 2 hours after eating and I'm a 5.0

probs end up getting told off by doc on next visit for not taking my tablets but o well, can't see the point of taking tablets to lower my blood sugar if it's low enough already.

the way i see it is if ya don't put any sugars into ya body, ya levels wont rise that much, and if my body wants sugar in the bloodstream it can jolly well make it's own

 

[brianb]

Hi
Try http://www.pharmacy2u.co.uk/ i got mine for the same meter for £9.99, dont know how that compares to your price.

I have also purchased from ebay whenever i see them, to be honest so long as they are in date i dont care where or who they are from, MY health is more important to me especially in this world where i have to resort to getting them from ebay because my doctor says its not important for a type 2 to test.......i bet he's got another good line when i go blind and loose a limb as well.

Brian

 

[Sweet3x]

Try Pharmacy2U - http://www.pharacy2u.co.uk
I used them before I worked out the French NHS system, and they were usually reliable. Not too expensive, either. £20 for the monitor, £5 for the pricky machine thing, if you can't do it by hand and £20 for the test strips (50)

 

[sugarless sue]

I've bought off Ebay several times with no problem.Check out seller reliability ,sometimes they are an on-line shop.

 

[SilverAndEbony]

This post is probably going to annoy a lot of people as most of the posters seem to have a completely different viewpoint than me. I don't want to stir up a storm, but on other forums I use people tend not to post what they think if the more vocal people have a different opinion.

Anyway - here goes....

I don't have type 1 do i have not idea what Type 1s should ideally be doing so I can't comment on that.

But I believe that, if you're type 2 there isn't the need to test all the time. Just a couple of times a week or if you're ill or something. i would say don't even think about testing your blood before 2-3 hrs after a meal. It's always going to go high - that's what it's supposed to do as you're digesting food and getting it into your bloodstream so it can get to where it will be stored. It should be under 7-8 2-3 hrs after a meal - and it should always be coming down not going up!

When I was first diagnosed I was advised to not test my blood YET! It's a lot to get your head around, and you blood levels are likely to still be the same as they were before you were diagnosed. You'll just get more stressed, which doesn't help anything. You're blood glucose levels are only going to show you've got diabetes - which you know already.
After a couple of months when things started settling down, both emotionally and my blood glucose levels, my diabetes nurse recommended I test a couple of times a week. 1st thing in the morning, just before a meal 2-3 hours after a meal. To be honest I'd say to trust what your diabetes team are telling you - or you'll get totally stressed out and that's really not good at all. When they think it's the right time to start testing they should give you all the info. She told me how to test as well as when and walked me through the actual process or taking a blood sample, control samples and everything.

It's only ever a snapshot so it can only tell you what's happening at that moment. if I get a higher or lower reading than what I know is normal for me, I take another reading at the same time as before to see if it's reproducible or a one-off. e.g if my before breakfast one is very high i take it before breakfast the next day, and if it's still high I take it the next day too.

I hope I haven't stirred up too much of a hornets nest!

Anyway, take care and look after yourself,

E

 

[Dennis]

Hi SilverAndEbony,
You are as entitled to your opinion as anyone else on this forum and if only testing your BS a couple of time a week allows you to maintain good control then you are very lucky. Unfortunately many of the people who turn to this forum for help do so because their blood sugars are not well controlled and they need advice on how to get them under control. Whether you agree with the idea or not, the only way you can ever know what your BS level is doing is to test it. Without doing that its like taking your car to the garage to find out why the engine doesn't work properly, but telling them they can't turn the engine on!

Type-2 diabetics have problems either with insulin production, or insulin resistance (or both), and the end result is increased blood sugar levels. If you don't test to find out what the level is, how on earth can you do anything about it? There was one particular comment of yours that I thought was particularly interesting

. . . and you blood levels are likely to still be the same as they were before you were diagnosed. . . . . . You're blood glucose levels are only going to show you've got diabetes - which you know already.

The whole idea of testing your BS is so that you can do something to change it, not just say "oh, thats interesting" but then not change anything!

Your argument is perfectly valid for anyone who'se BS is well controlled, but for anyone with badly controlled BS it at best inadvisable and at worst highly dangerous.

 

[SilverAndEbony]

Hi Dennis,

Thanks for your response - I am interested to know what people think, and how they come to their conclusions. As you say, everyone is entitled to their own opinion. I'm being a bit nosy I think

My comment about testing your blood glucose levels telling you what you already know that is when you've just been diagnosed when your glucose levels are not good, and it's all pretty much too much to cope with. It's too easy to become completely overwhelmed with everything. I was obsessed about my diet and exercising all the time but my glucose levels were still not good. If I had been testing myself, rather than seeing the diabetes nurse for check during the first month - 6 weeks after diagnosis I hate to think what state I would have been in. But that's me, and everyone's different. Once I started on Metformin I started testing my blood myself. I think I get very stressed very easily, so that plays a big part in how my GP and diabetes nurse treat me.

I suppose I'm interested to know other people's experiences of how they developed their own testing regime. Especially as what works for someone else might help me work out what works for me!