Type 2 Diabetes and Daily Blood Sugar Monitoring

Research is telling us that those with Type 2 diabetes don't need to be testing for blood glucose levels at home and that doing so is a waste of money and a strain on the health care system.

Other HCT Episodes on Diabetes:

Healthcare Triage Links:

Credits:
John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen – Art Director
Meredith Danko – Social Media

#diabetes
#bloodsugar
#healthcare

[healthcaretriage]

Hi! Like this episode? We've made some other HCT Episodes on Diabetes, if you want check them out:

[arcee]

No, it was useful especially on the first month diagnosed as a diabetic. It really helps me choose what food to eat that doesn't spike my blood sugar. It motivates me to continue lifestyle change. And I don't want to end up being insulin dependent.

[nicksvisiontohear]

This is wrong, I live in Australia where we get strips heavily subsidised. So, in this doctor's opinion we shouldn't worry about test BUT wait every three months for the A1C test? The only way to lower the A1C is to check your levels daily so you know what to eat.

[curiousfirely]

Ok. So my argument is that once per day is NOT ENOUGH for Type 2 Diabetes, at least at the beginning. A large part of the treatment for Type 2 Diabetes is diet and exercise. In order to understand the effect of these on blood glucose properly, much MORE glucose testing is needed, or even use of a continuous glucose monitoring system. This type of treatment does not need to be forever, but for a few months so patients can understand the link between their actions, and their blood glucose.

[dangerimp]

I completely disagree with the research on this. I'm type 2 and I now have continuous blood sugar monitoring (Libre Freestyle, love it) and it has made an huge difference in my care and my overall blood sugar. Without being able to see realtime and continuously how what I'm doing affects my blood sugar I wouldn't have made some of the changes I've made to my diet. I understand that a lot of type 2 people have a hard time changing their diets and that it's quite likely that testing isn't affecting their motivation to change their diets, but that's not a reason to stop testing.

[NancyLebovitz]

For what it's worth, I've got type 2 non-insulin dependent, I was diagnosed about eight months ago, and at this point I mostly test daily. I've found out a lot about what raises or lowers my blood sugar. For some reason, I can handle rice congee but not rice. Sweet potatoes are surprisingly bad. Algae supplements seem to help.

And insulin is *very* expensive compared to test strips. I seriously doubt that test strips and lancets are sucking that much money out of the system.

[marianne]

Totally disagree!! It was only when I started doing my own testing to see how which foods spiked my BG that I was able to drastically lower my A1C from 8.5 to 5.2. The meter keeps .e motivated and healthy.

[gouravdash]

We check blood sugar level to keep it under control and whenever it goes out of control we immediately take the necessary steps to get it under control.

[BobHuttonAU]

I have Type 2 Diabetes.

I was put on a (government funded) diabetes management program, which involved, amongst other things, for the first month or so, testing my blood glucose level multiple times a day:
- When I woke up.
- Just before a meal.
- 2 hours after a meal.
- Before I went to bed.

I found it really useful having direct feedback about the food I was eating. Rather than choosing foods for some vague benefit in the future, I had an immediate measure about its effect on me. Through this process I figured out that (amongst other things):
- Foods labelled "Low GI" are fine.
- Foods with low carbohydrate and sugar levels are probably ok.
- Foods with high carbohydrate and/or sugar levels are real bad.
- Eating too much in one meal is bad.
- Not eating for too long is bad.
- If I have been doing heavy exercise, it doesn't matter much what I eat.

I now only test my blood if I do something different, like go to a restaurant I haven't been to before (and would consider returning). I also have to convince my GP that I'm using the tests responsibly to continue getting a government subsidy on the testing strips.

It's been a couple of years now and, so far, I have no observable symptoms (other than blood tests).

I realise I am only one data point and I can't re-run the experiment without the self-administered blood tests, but I think it would be a real shame if those of us that can demonstrate we are using the tests responsibly, don't have ready access to them.

[AnchorMoments]

I am new to type 2 diabetes. I am using the Freestyle Libre sensor on my arm to help me figure out what makes my sugar go up and down in real time. It has been so helpful to me so far!

[MIKESKDAWG]

I have type 2. I test my blood about 8 times a day. I have dropped my blood sugar from a 547 to a 130. No meds at all just eat less, fast, no sugar and low carb. I also watch Dr Jason Fung for advice. So I say do what you think works best for you. And don't listen to some of these so called professionals.

[kjvwarrior]

Went for a check up, at 55, the Dr couldn't believe I wasn't diabetic, he keeps running test to prescribe medication, but he keeps failing like he really want to prescribe medication. I simply don't eat the crap food companies want you to

[solitaryrefinement]

I knocked down my Type 2 A1C to 5.4 from 11.2 and I used testing to monitor my progress and how I reacted to different foods. Yeah, 300 bucks a year is a small price to pay for those kind of results.

[thatjillgirl]

As someone interning in a diabetes clinic, that caveat "type 2 diabetes NOT ON INSULIN" is pretty crucial. Testing more than once a day is a waste ONLY if the patient is stable and well-controlled on all their medications and none of those medications are insulin. Any changes to the insulin dosing really need monitoring of more than once a day to assess the effects.

But yes, if patients get to where they're stable, controlled, and not on insulin, they don't need to test more than a few times a week, if that.

[tomjur]

As always, a great breakdown of a very important health issue!
I want to point out some things about the Monitor trial:
Patients in all three arms had pretty low A1cs at baseline (at least compared to my patients), and the vast majority of patients have had diabetes for >1 year at baseline.
Like you said, it's not news that SMBG does not significantly improve outcomes in patients like these.
However, the patients that were underrepresented are those with very uncontrolled diabetes (but still non-insulin dependent), and those newly diagnosed. These patients most definitely need to be followed very closely.
Also notice how the two SMBG arms were in the controlled range until month 6, then suffered a slight increase by month 9, and then BAM! Back to baseline at month 12!
I think this is the largest highlight of the study - that no matter what we do, patients might do great in the first few months after an intervention, but then suffer disease fatigue and regress back to baseline (this is touched upon by the authors in this trial, which is great).
This showcases the importance of keeping up with patients and making sure they're not burning themselves out - diabetes is an entire lifestyle change, which can be very mentally challenging (the anecdotal new year's resolution failure).
That's the biggest take-away from the study. Not the fact that SMBG in slightly poorly controlled, long-standing diabetes is useless in the long run (12 months). Rather, it's the fact that all patients suffer from some form of fatigue and need to be on our radar in some way (which will reduce healthcare costs in return).

[moatzmoatz]

I bought a glucometer out of pocket, and was a tremendous help identifying culprit foods. I did not give a rip about AM or premeal levels--but tested AFTER eating, to SEE what was spiking my glucose. I was able to stop Metformin.

[jennandersen]

I have serious reservations about these recommendations- patients who are changing regimens, are sick, etc. can't get extra test strips from their insurance because they are not 'medically necessary'. We do a poor job with diabetes education for patients who have type 2, and these patients are not always taught the importance of self-foot checks, dilated eye exams, and have less primary care follow-ups and provider administered foot exams. People with type two are (especially when developed young which is more and more the case) are at higher risk of complications which drive up healthcare costs. Daily monitoring (or even better, CGMs) allow for patients to know how food/stress/exercise affects them, and allows for changes that can be managed by the patient. Prevention now, or cleaning up the mess later? I know which I prefer. Let's teach people with type 2 how to manage their disease so they don't risk future complications- just like I get to with type 1. Not to mention the mere fact that treating people with type 2 differently that those with type 1 perpetuates stigma and leads to healthcare inequalities for those with type 2.

[MrMehawk]

I don't know if you changed anything about your setup, camera or lighting recently but the video quality has been amazing recently.

[gooberfishin]

A a diebetic, it is great to know there's a new opionion about treating diabetes out there. When I was diagnosed with type 2 diabetes, I was told to not eat anything with sugar in it. The grocery store became a food desert over night.

[lightbox]

Oh, No. A credentialed professional looks at verified data and tells the truth. Thanks again Aaron. I live in Newark, NJ, USA and if you want to see the market in "test strip loosies", come here. You can sell them in batches of 10 to 50 but buy them at an inflated price in singles . None of the authorities here knows how to stop it or even if it is not legal. This is NJ it may not be illegal. Some old black guy can be killed by Staten Island police for selling single cigarettes but the open advertising to purchase (and by implication, re sell) single diabetes test strips is overlooked. Come to Newark and I'll show you