Why Testing Matters (Use It or Lose It)

Say what? Am I really sitting here reading all these headlines about how glucose testing supposedly makes no difference for treating diabetes? No. Worse. That it could actually be harmful to diabetics because they’re more likely to become anxious or depressed if they check regularly?

I know I’m preaching to the choir here, but drawing this kind of doofus conclusion that subsequently gets splattered all over front page media just makes me soooo mad.

This story originated in the peer-reviewed British Medical Journal. In a project known as the ESMON study, British researchers investigated the relationship between self-monitoring of blood sugar, actual blood sugar control and mental health. They used just under 200 people newly diagnosed with Type 2 diabetes, split them into two groups, one that monitored and one that didn’t.

“Those who were self-monitoring had significantly higher scores of depression at the end of the study (by 6%), but there was no difference in levels of anxiety, general well-being or energy.”

Yeah, well, they probably weren’t keen on being under pressure to test all the time, especially being so new to the whole D-game.

I think I’ve told this story before, but I keep flashing back to that old college friend of mine who was diagnosed with Type 2 last year while I was writing my book. He’s an educated guy who runs the IT department of a small private university. He called for a tip, embarrassed. Turns out he was sent home with a glucose meter, but given no idea what it really was supposed to do for him.

“I keep getting these numbers, and writing them down. They’re mostly pretty high. So what does it mean? What do I do with this information?”

I nearly screamed into the phone.

Clearly, glucose testing does absolutely NOTHING for you if you don’t know what to do with the results. It’s just a bunch of useless numbers that your doctor may or may not scold you over. And why would you even consider it when you read all these reports about how testing’s going to lower your quality of life?

I think all the glucose meter companies should get behind this one: we need a national awareness campaign about Glucose_meter1what the heck to do with your glucose meter (other than stare at it and get depressed). Let’s push the education agenda, rather than just new models with fancy features.

Most of us Type 1s are all over it, since we have little choice. Allow me then to provide a couple of very basic tips — straight from our book — that you all might like to share with any diabetic family or friends who haven’t gotten a proper education about translating meter results into better health:

* test before and after specific foods or meals – you can gauge how that food effects you, and maybe cut down on it, quit it, or plan to eat it before exercising (to offset the BG spike).

* test before and after exercise – to gauge how that activity effects your blood sugar. You may not need a snack every time you go for a walk after all, for example.

* test at same time(s) every day – look for trends. Are you always high after dinner? Always low before bedtime? Now adjust your food or medications to compensate.

* remember, your A1c tells you how you’re doing overall, but doesn’t tell you diddly-squat about your day-to-day routine. Only individual daily glucose results can indicate whether you need to consider changing your breakfast menu and/or scheduling your exercise for a different time of day.

* by the way, it might help to think of it as “Glucose Checking” versus “Testing.” It gives you information, not a valuation of your worth. No need to feel that you have to “pass” every diabetes-related test you take.

Heck, we all know that diabetes studies can lead to confusion. I just wish they’d be a little more careful about blasting out the message that the best tools we’ve ever had for diabetes care aren’t worth using. Aaarggh.

Advertisement

21 Responses

  1. elizabeth joy
    elizabeth joy April 23, 2008 at 7:09 am | | Reply

    Well testing does lead to depression (Something must’ve happened with my pump in the middle of the night because my sugar was 465 at 3AM. AND YES, I was definitely depressed!) But complications will make you even more depressed, no?

    On the other hand, my endo actually posted about this on his blog, and says he agrees, and that he tells his Type 2′s self-monitoring every day isn’t necessary–but he only tells them this after they’ve gotten their sugars more or less in control. So I think he’s implying that as long as his patients are compliant with carb counting and medication, regular testing doesn’t tell them much, because the same foods/activities are going to affect them pretty much the same every day. (Obviously NOT true for Type 1′s.)

    I hope people won’t read this as an excuse not to test, though (just like I hope people don’t use the ACCORD trial as an excuse not to stay in control.) If your sugar isn’t in control, and you don’t stay on whatever diet you’ve been given, testing is just as crucial for you as for T1′s.

  2. elizabeth joy
    elizabeth joy April 23, 2008 at 7:10 am | | Reply

    Well testing does lead to depression (Something must’ve happened with my pump in the middle of the night because my sugar was 465 at 3AM. AND YES, I was definitely depressed!) But complications will make you even more depressed, no?

    On the other hand, my endo actually posted about this on his blog, and says he agrees, and that he tells his Type 2′s self-monitoring every day isn’t necessary–but he only tells them this after they’ve gotten their sugars more or less in control. So I think he’s implying that as long as his patients are compliant with carb counting and medication, regular testing doesn’t tell them much, because the same foods/activities are going to affect them pretty much the same every day. (Obviously NOT true for Type 1′s.)

    I hope people won’t read this as an excuse not to test, though (just like I hope people don’t use the ACCORD trial as an excuse not to stay in control.) If your sugar isn’t in control, and you don’t stay on whatever diet you’ve been given, testing is just as crucial for you as for T1′s.

  3. elizabeth joy
    elizabeth joy April 23, 2008 at 7:11 am | | Reply

    Well testing does lead to depression (Something must’ve happened with my pump in the middle of the night because my sugar was 465 at 3AM. AND YES, I was definitely depressed!) But complications will make you even more depressed, no?

    On the other hand, my endo actually posted about this on his blog, and says he agrees, and that he tells his Type 2′s self-monitoring every day isn’t necessary–but he only tells them this after they’ve gotten their sugars more or less in control. So I think he’s implying that as long as his patients are compliant with carb counting and medication, regular testing doesn’t tell them much, because the same foods/activities are going to affect them pretty much the same every day. (Obviously NOT true for Type 1′s.)

    I hope people won’t read this as an excuse not to test, though (just like I hope people don’t use the ACCORD trial as an excuse not to stay in control.) If your sugar isn’t in control, and you don’t stay on whatever diet you’ve been given, testing is just as crucial for you as for T1′s.

  4. elizabeth joy
    elizabeth joy April 23, 2008 at 7:14 am | | Reply

    Oh my gosh–I have no idea why that triple-posted!! Sorry…I’m usually not so adamant at getting my point accross.
    ;)

    Can you delete the extra posts, Amy?

  5. Kendra
    Kendra April 23, 2008 at 7:15 am | | Reply

    As a Type I I understand what to do with my numbers. So that’s fine. I could scream with frustration all day long for the Type IIs I run into who know alllll about calorie counting but nothing about their blood sugar numbers or carbohydrates.

    I am annoyed at the insinuation that testing more often can be harmful because it’s depressing. Why blame the testing? Having diabetes is depressing sometimes — the disease is the real culprit, not the information. (Insert “knowledge is power” spiel here.) Having “bad” numbers is never going to cheer me up, but I don’t feel bad because I’m testing, I feel bad because I have diabetes. This is a slap-your-forehead moment if I ever saw one.

  6. Jillian
    Jillian April 23, 2008 at 8:11 am | | Reply

    This just shows the huge difference between Type 1 and Type 2. If you think about it though, a Type 2 doesn’t necessarily have the tools to make “bad” numbers better. As Type 1′s we have insulin for correction. But a Type 2 can only look at a number, write it down, get depressed, and continue with the day if they aren’t on insulin. Monitoring and logging is all well and good, but if a person with Type 2 doesn’t know how to work on numbers in real time instead of just waiting to see the doctor every few months it’s stupid.

  7. tmana
    tmana April 23, 2008 at 8:18 am | | Reply

    I’m T2, looking at multiple sides of the issue.

    The research: the study had too few participants, for too short a period of time, and not testing nearly enough. For T2 testing to mean anything, one still needs to test for tight control just like T1s (minimum 8 tests/day: rising, pre- and post-prandial, retiring) and — because it is T2′s only way of affecting those numbers — adjust one’s diet and exercise based on the results of the meter. Additional checks before and after exercise, and when dealing with unfamiliar foods (or unfamiliar quantities of familiar foods), help in the overall picture.

    Insurance and medical advice: Many folk with T2 are told that their insurance either won’t pay for strips or won’t pay for more than 1 test a day (or less). When I was first diagnosed in 2002, my PCP told me insurance companies ***would not pay for more than 4 tests a day, FOR SOMEONE ON INSULIN***… This leads PCPs and CDEs to advise T2s either to test daily, always at the same time, or to test in a pattern at specific different times on different days of the week. The result that is it takes much longer for patterns to appear and for the numbers to have any meaning. The waiting game can cause anxiety, especially if the patient is treated like the proverbial mushroom.

    Patient Self-Management: The third issue in the effectiveness of blood glucose testing for NIDDM patients is the how aggressively the patient is willing to be in his diabetes management. If the patient is not willing to adjust diet and exercise based on bg readings, and if the patient is not willing to keep track/keep a log/understand the meaning of the numbers, testing becomes expensive, painful, time-consuming, and — to the best of his understanding — irrelevant.

    All of these issues need to be addressed for blood glucose testing to be meaningful to T2 patients. For me and for my Other Half (also T2), it is meaningful. For his father (also T2), it is mostly a hollow exercise in log-keeping (though he does understand “lows”). For my mother (also T2), it is something her PCP never brought up, something which she is not interested in doing, and irrelevant because she would not to use the information to improve her diet or exercise.

  8. Susie
    Susie April 23, 2008 at 9:34 am | | Reply

    I am T2 and I think it is ridiculous to state that testing is not necessary just because your bg is “more or less” in control.
    we are not robots and are not going to be eating the same foods each day at each meal. There are so many things that affect blood sugar. You can eat a meal with the same amount of carbs and have completely different sugar levels depending of the gylcemic index etc. etc.
    I test about 8 times a day. My dr initially had me test like 2 times a day varying the time I tested. However, I wanted to test more so that I can be in control of my blood sugars. My dr. was thrilled and whole-heartedly agrees that it is beneficial to me. If I see a trend of highs, I can adjust my diet more or go for a brisk walk. Or if it continues, I can call the dr. and we can make adjustments before- not knowing and waiting until the next visit. Or before I exercise, I can see what kind of snack I need etc. to avoid a low during the work-out.
    All i know, is I use my meter results to help me plan better for the next meal or workout. Just because I am T2 does not mean that I do not deserve Tight control or the tools that I count on that I feel give me that. I hate studies like this. People have enough stereo types about T2 people, that they are lazy and caused their own disease etc. Now it’s like if they could, they would add brainless to the list.

  9. Susie
    Susie April 23, 2008 at 9:36 am | | Reply

    I am T2 and I think it is ridiculous to state that testing is not necessary just because your bg is “more or less” in control.
    we are not robots and are not going to be eating the same foods each day at each meal. There are so many things that affect blood sugar. You can eat a meal with the same amount of carbs and have completely different sugar levels depending of the gylcemic index etc. etc.
    I test about 8 times a day. My dr initially had me test like 2 times a day varying the time I tested. However, I wanted to test more so that I can be in control of my blood sugars. My dr. was thrilled and whole-heartedly agrees that it is beneficial to me. If I see a trend of highs, I can adjust my diet more or go for a brisk walk. Or if it continues, I can call the dr. and we can make adjustments before- not knowing and waiting until the next visit. Or before I exercise, I can see what kind of snack I need etc. to avoid a low during the work-out.
    All i know, is I use my meter results to help me plan better for the next meal or workout. Just because I am T2 does not mean that I do not deserve Tight control or the tools that I count on that I feel give me that. I hate studies like this. People have enough stereo types about T2 people, that they are lazy and caused their own disease etc. Now it’s like if they could, they would add brainless to the list.

  10. Khurt Louis Francis Elliot Williams
    Khurt Louis Francis Elliot Williams April 23, 2008 at 10:19 am | | Reply

    My father-in-law ( Type 2 ) learned the hard way about checking before and after exercise. After taking his medication ( but before eating ) he got on the treadmill for 30 minutes. My sister-in-law called me i a panic when her father suffered a serious low (47), started shaking, and couldn’t breath.

    He now checks his BG 5 times a day.

  11. Laura Williams
    Laura Williams April 23, 2008 at 11:26 am | | Reply

    I agree so much. Those studies and headlines are always get me upset. And not a single on says anything about training people to RESPOND and REACT to their sugar results.

    If a doctor gave me a blood meter, didn’t let me/tell me to change my diet and had me test all the time, I’d find it pretty bloody useless too.

  12. carol
    carol April 23, 2008 at 11:51 am | | Reply

    I was a late (slow) onset Type 1. They tried me on oral meds, which worked for about 6 months (now I know that was the honeymoon). During that time I didn’t check my blood sugar very often either because it seemed there was nothing I could do about it. Now, I make decisions many times a day based on my readings (using my insulin pump), and would feel naked without my meter. All depends on what you do with the info, if anything. BG numbers, like any other numbers are pointless unless used to make decisions.

  13. Felix Kasza
    Felix Kasza April 23, 2008 at 11:53 am | | Reply

    The study dealth with type 2 NIDDM — treatment was through diet, exercise, and oral meds.

    It is absolutely true that BG monitoring at home is perfectly useless in this scenario; it’s not as if one could pop another pill if one’s BG were too high.

    I don’t see what all the hue and cry is about.

    Cheers,
    Felix.

  14. Aaron
    Aaron April 23, 2008 at 12:14 pm | | Reply

    Yeah. Doctors who haven’t lived with diabetes can miss the real story. I’ve been type 1 for 24 years now, and there was a period of 6-7 years (adolescence) where I didn’t test much. It’s just soooooooo soooooo so obvious to me that life with glucose regulation via frequent testing is the only way to go. It’s not even worth studying. Yeah, there were times when it wasn’t easy, when the obsessing and worrying over all my BGs made me unhappy, but that’s just a temporary phase. How many great piano players or doctors or whatever didn’t go through some level of frustration with their training? It’s just part of growing.

    Ask any type 1 what it’s like to go for a jog with a blood sugar of 100, 200, or 300. We don’t need a controlled study to know what feels right for the body. Of course, someone who is chronically 200 wouldn’t know what it’s like, because they have no idea what ‘normal’ is supposed to feel like.

    The body can get used to the feeling of chronically high blood sugars, in the same way that it can get used to the feeling of always having alcohol in it’s system. Getting your blood sugars in good control is like getting clean, and it’s likely to be just as much of a struggle to get to that point.

  15. Glucoholic
    Glucoholic April 23, 2008 at 6:25 pm | | Reply

    I think that doctors dealing with newly diagnosed Type 2s see such a hard road to getting patients to do the most basic of things that it might lead them to say “If testing makes the patient somehow feel they have failed, and that feeling leads to less compliance in other areas, then I’ll take my chances with less testing.”

    My physician asks me first thing every four months “Are you taking your medications?” I sometimes ask why he needs to do this every single time and he relates to me that large numbers of his patients do not take their prescribed medications.

  16. whimsy2
    whimsy2 April 23, 2008 at 7:57 pm | | Reply

    Excellent post, Amy!

    I’ve had type 1 LADA for 10+years now and I still need to test 10x every day — before each meal so I know how much insulin to take (I don’t pump but I use the same system – insulin matched to carbs with fast-acting insulin). And I test 1 and 2 hours afterwards to see how I did. That way, next time I have that meal I’ll know if an adjustment needs to be made.

    Then of course I DO test before and after exercise. And before I go to bed. And when I get up in the a.m. And if I feel funny. I use an average of 10 strips a day and thank goodness for my job which covers 90% of strips cost. I think more people would test more often if strips weren’t so exhorbitant. And if more people were told what to do with the results of their BG test, as you so aptly blogged.

  17. Anna
    Anna April 24, 2008 at 12:05 am | | Reply

    Nice post

  18. Gene
    Gene April 24, 2008 at 2:30 am | | Reply

    I have to agree with Jillian here. It seems to be a very small study with little value. What were the endpoints of this study–feelings of “intrusiveness”?? Well, those little lancets can be a tab intrusive, I suppose.

    Drawing meaningful conclusions from this study for the diabetic population as a whole would be obvious folly.

  19. Bonny C Damocles
    Bonny C Damocles April 26, 2008 at 9:02 pm | | Reply

    Testing does not matter to me anymore. It used to when I was newly-diagnosed as a t2d in July 1991. My diagnosis fasting sugar reading was 468 mg/dl.

    My only t2d medication has always been exercise. Of course, I have to eat only heart-healthy foods, mostly carbohydrates. And I must always make sure that I strictly follow healthy habits, like having enough sleep, drinking adequate clean water, seeing our family physician, family dentist, family opthalmologist, and cardiologist on a regular basis.

    After more than 16 years using exercise as my only t2d medication, I am seeing great improvement in my health. Every time I test which is on average about once every 3 days (have to use up 25 strips in 90 days) I get a normal reading.

  20. Kenn Chaplin
    Kenn Chaplin April 29, 2008 at 6:50 pm | | Reply

    I appreciate this information so much. I have been in the habit of testing first thing in the morning, taking my meds, and ignoring my meter until the next morning – so I like the idea of checking to see how my snack and meal choices affect my levels. The way you put it makes so much sense (but I’m glad I’m not the only one who has had a huge question mark over my head) :)

  21. Shaking my fist at diabetes « My journey with AIDS

    [...] P.S. Suspicious as I am of potential spam, I’m pleased to say that I found a very useful article on the rationale for glucose monitoring by following the first comment here to Amy’s site. [...]

Leave a Reply