December 20, 2011

Important Tests Needed By People With Diabetes - P2

Back in August 2010, I wrote about five or six important lab tests for people with type 2 diabetes. I need to update this and add more tests and be a little more detailed than I was then. It is not my intention to discuss the tests for gestational diabetes, but a few are common across all diabetes types. The discussion for this blog is about monitoring diabetes, by your doctor and by you.

Once you are diagnosed with diabetes, the glucose (or blood glucose) test will become very important to you. This test has other names starting with fasting blood glucose (FBG), or fasting plasma glucose (FPG). This is done either in a lab or in the doctor's office lab. Normal fasting is required of a minimum of 8 to up to12 hours. This is done by drawing blood from you and gives two results. The first is the fasting plasma glucose reading and the second is the A1c results. Normally other tests are done at the same time, but this discussion is on glucose. An A1c test can be accomplished without fasting and is often done this way.

These tests can be performed at various intervals depending on the patient and the doctor. If the doctor is overworked and the patient is active in his/her care, some doctors only see a patient once a year. Others see their patients twice a year, but most doctors still try to see their patients with diabetes four times per year.

The blood glucose (or glucose) test will become one of your daily tests. This is not the same as the blood glucose test taken in the doctor’s office or lab. This requires a blood glucose meter and test strips and is done several times per day depending on the type of diabetes you are diagnosed with and the limits of test strips mandated by your medical insurance or Medicare. This will also depend on whether you are on oral medications, insulin, or a combination of the two.

If you can afford to purchase test strips on your own over and above what your insurance or Medicare covers, please consider doing this. If extra test strips are over your budget, pick times for study like your fasting after arising in the morning. Know what you wish to attain and look to this test for guidance. Then pick another time during the day, which will assist you in maintaining your goals. Then after a period of time switch your testing times and use them for about a month. Be prepared to return to the original testing times if the secondary times are well managed.

One of the reasons for encouraging people to purchase extra test strips over what insurance reimburses is to test what different foods do to your blood glucose levels. This requires you to test after every meal at approximately 1 to 2 hours. This will tell you if you need to reduce the portion or eliminate the food from the menu. Because everyone's body chemistry is different, it is important to become you own chemistry experiment and learn by testing how the different foods affect you.

Until you learn to count carbohydrates from a dietitian or certified diabetes educator or another professional, the testing will only give you general ideas. Get a referral by your doctor and lacking that, call your insurance company and ask them for permission or a list of registered dietitians knowledgeable in diabetes.

Yes, we can say to eliminate certain foods and often encourage people to do so because of our own history and the history of others with type 2. However, everyone being different, it is still best to test for yourself. It is almost like a symmetrical bell curve with carbohydrates. Some people can only tolerate a small number of carbohydrates and people at the other end of the curve can tolerate more than the average person. The American Diabetes Association treats everyone the same in the number of carbohydrates they can consume. This is far from the truth and is a reason for testing more shortly after diagnosis. Once you have found your level of carbohydrates, then reduce testing to what insurance or Medicare will reimburse.

I would also suggest that more testing be done again when foods are changed or blood glucose levels from your tests show an increasing trend. Maybe you can reduce the number of carbohydrates consumed without increasing testing, but for those of us that are very conscious of blood glucose levels, we like to be sure. Read my blog here for testing.

What we are looking for is trends and hopefully the levels are steady and not increasing. When blood glucose levels are trending upward, this will most likely be reflected in your next A1c test and you should be ready to discuss this with your doctor. Most endocrinologists will want to take readings from your own meter and see what readings you are getting. Not all doctors want or can deal with this information so always be prepared.

Several bloggers have also discussed this topic and I offer their discussions for your reading as they can possibly shed a different perspective on this subject of testing that will make more sense to you. Tom Ross has two blogs that may assist you in knowing how to test if on a limited supply of test strips. The first is here and the second with additional thoughts is here.

Joslin Diabetes Center has a blog here and Alan Shanley has a blog here about the importance of testing. Alan's second blog is here. The blogs by Tom and Alan are important as they also have type 2 and presently Tom is managing his with diet and exercise. 

Part 2 of 4.

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