pipstick said:
Hi Ian,
I'm a DESMOND educator, and we constantly get asked about monitoring blood sugar levels. There was (fairly) recently a study done on SMBG (self monitoring of blood glucose) where three groups of newly diagnosed patients were randomised into 1, blood glucose testing 2, urine testing and 3, nothing at all. it showed that all three had good benefits, including doing nothing at all. there is a problem with quality of life being affected as well with testing you blood/urine sugars in that it's a bit like dieting and getting on the weighing scales every day - you can get a wee bit obsessed with it. the blood sugar testing only shows what your blood glucose levels are for that moment in time, if you did it again 5 or 10 mins later, you could get a completely different result. there are lots of things that would affect your glucose levels, inlcuding stress, illness, activity levels, mood, so it's not just food/drink that affects your levels. where i agree that a target blood glucose level is 4-7mmol, i wouldn't necessarily say that you have to monitor them yourself to get a good result. your HbA1c that they do every 3 months is a much better indicator of your progress (think of it as if you checked your blood sugars every second of every hour of every day for 3 months!). does this help? pm me if you need to.
I am quite shocked that you are a DESMOND educator...
As you don't seem to take on board that HbAc is actually flawed...
HbA1c is totally based on an adverage over a period of time it has no ability to provide a SD (sandard deviation) which is a very important factor of understanding if control is good, bad or ugly even at depicting a risk factor it has it's limitations... And it does absolutly nothing to detemine day to day control, whether food/drink, exercise, stress, illness has had any impact to it's result..
So a T2 is diagnosed, you send them off with some information concerning food choices, and some tablets and come back in 3 months and we see how you'll doing.. At this point their HbA1c is 7%... 3 months later they return for the review and their HbA1c is 9.8%
Now ask yourself why this may be?
Which you can't answer as the HbA1c won't tell you, as it can't tell you whether this is food related or not.. Nor can your patient say whether it's based on stress or whether they've been ill as such... Can you remember what you ate of the 4th September, did you feel stressed or had a snotty nose, I sure know I couldn't without looking at my data...
But the HCP is willing to up medication etc based all one figure in front of them :shock:
Worse is that the patient themselves are left clueless to what they might change within their lifesyle to improve things.. So next review will it have changed or got worse..
With T2's more so at the begining they do need the ability to test frequently, not just a couple times of the day, but before/after meals, when exercising or if they feel off... Then they need to be taught how to interpretate this data... So they can see that yes they could change something perhaps cut back on their food intake, or avoid certain foods at certain times or completely.. Or perhaps add a bit more excercise into their routines.. But once they've got it sorted, then they only need to test a couple times a week, or when ill or routines change or something new happens...
Then when they have their review. the HCP can make a clinical decision from full facts rather than just stabbing in the dark...
And I'm a T1 diabetic by the way