January 9, 2013
Tips for Glucose Testing – Part 3
Part 3 of 4 parts
When Is It Best To Test?
This will depend on your budget and the amount of test strips you have available. It will also depend on the medication(s) you are using. Insulin will require, by its very nature, the most testing, especially is you are using a basal (long acting) and a bolus (short acting). Normally you will test upon waking and this will be the before breakfast test as well. Next will be your after eating (postprandial) for breakfast. You should consider doing this for all three meals and again before bedtime. This makes seven times at least per day. Then if there is a question about one of the tests, another test may be added. Doing the tests at approximately the same time each day will be of value in watching for trends and problem times when adjustments may be necessary. It is also wise to test before and after exercise. Read my blog here about safe blood glucose levels for exercise.
What the article from Diabetes Connect does not talk about is the reason for pre-meal testing. This is for determining if adding a correction factor to go with the bolus injection based on the carb count for the next meal is needed. One point I admit I have never understood is there are some sources that insist blood glucose testing should be done at approximately the same time every day. Do they mean within 15 minutes, 30 minutes, or two hours. In talking with my doctor, he suggested probably 30 minutes, but said he understood why I would be asking as being retired, I do not have a schedule. If I need to be up at 7:00 AM, that is when I do my fasting test. Other days I don't arise until 11:00 AM or later and that is my fasting test time. My wife has a work schedule and I gravitate to her schedule, but don't follow it exactly. The only thing I watch very closely is not overlapping my short-acting insulin injections.
If you are on oral diabetes medications, then I can understand holding to a more consistent schedule. By doing this you will generally get the most consistent and effective results from your medication and not be overlapping the same medication, which can cause serious problems. The other caution with oral medications is eating approximately the same number of carbohydrates per meal. This will depend on the dosage. It is wise to discuss this with your doctor and asking about times when you don't feel like eating or are ill.
Understand Daily Glucose Testing vs. Your A1C Result
Are you one of those people that believe because you have a quarterly A1c done or like some, buy the home A1c kit and test your A1c every month, think that you don't need to do daily blood glucose testing. This is the wrong line of thinking and for several reasons. For the most valid reasons for the error in thinking this, please read this blog by David Mendosa. One statement that really stands out is this, “The plasma glucose in the preceding 1 month determines 50% of the HbA1C, whereas days 60 to 120 determine only 25%,” This means that 75% of any A1c result in from the previous 60 days.
In reading the selection by Diabetic Connect, I must respectfully disagree with the use of the ADA standard of A1c levels of less than 7%. This is still in the danger zone for allowing the onset of diabetes complications and progression of diabetes. Even the American Association of Clinical Endocrinologists (AACE) standard is 6.5% is not the best for everyone. I do agree that it is closer to ideal than the ADA standard will ever be. As a person ages, allowing the A1c to creep up toward the AACE standard is more acceptable. Still if the person is capable of obtaining A1cs of 6% or less, there is less likelihood of complications developing.
Therefore, if you receive and A1c of 7.4%, you know that something is not right and changes need to be made, but what is the question. By having your daily blood glucose log, you can review this and maybe discover where you need to make changes, especially when matched with your daily food log. If you met your A1c goal, and have not had frequent or maybe one or two minor low blood glucose readings, you can feel fairly confident you are achieving your daily blood glucose levels. Clinical research is telling us that our A1c readings is vital in predicting our future health, but our daily blood glucose readings are important in meeting our A1c goal and tells us how we are doing on a daily basis.
No Judgments, This Test You Cannot "Fail"
“Always remember and never forget: testing glucose is not a judgment of your personal worth. This is not the kind of test that you either "pass" or "fail." In fact, all glucose readings are good! — good in the sense that if you hadn't checked, you wouldn't have that information.” This is what the author of the article in Diabetic Connect stated. Do you agree? I do and only because each reading is relative to that period in time and can be an indicator of the progress you are making in your diabetes management, or not. If your blood glucose readings are always above 200 mg/dl then your A1c will reflect this and your doctor will wonder what your goal is and what you are not doing to lower your A1c. So in that sense you have not succeeded, but the only person you have failed is yourself.
If your goal was an A1c of 6.5% and your A1c is over 9.0%, you have not been paying attention to your daily blood glucose readings, getting the exercise needed, adjusting your food plan, or asking the right questions of your doctor to assist you in getting lower readings. Occasional high readings can mean a lot of stress, you are becoming ill, are overtired, or had more to eat of the incorrect foods for a meal or two. Try to determine what caused the higher than expected readings.
A high reading will not bring on complications unless you have high readings consistently for months on end. Then your doctor may decide that you need to make some changes, often drastic, to reduce your A1c and stop the onset of complications. If you are consistently over 200 mg/dl, you may wish to consider using insulin for managing diabetes more effectively. At least do some reading about insulin to have an informative conversation with your doctor.
How to Choose (Or Obtain) a Meter
This is important and not to be dismissed as your meter will become a good friend and is a needed tool in your management of diabetes. Do not be put off, repeat, do not let the doctor discourage you from having a meter. It is unfortunate that there are many physicians with patients having type 2 diabetes, that won't give out meters or even encourage testing. If you have one of these doctors, I urge you to consider finding a doctor that will. I have even had a surprise that a doctor discouraged a type 2 patient on insulin from testing. This was a shock and I told the person this could be deadly to him without a meter and he should see another doctor before he even considered returning to his doctor. In discussing this with the individual, he had been told to eat only a certain number of carbs for each meal. I asked if he even knew what to do if he was ill – he was told not to inject insulin if he could not eat. Even this is bad advice without testing.
Today, many doctors and endocrinologists have meters that they will give you. If you have medical insurance, there is often nothing wrong with accepting one of these meters. Often the meter they will give you is one of the better and more reliable meters. If you do not have insurance, then read tomorrow’s blog (part 4) on financial assistance. Some medical insurance companies are very restrictive about what they will allow coverage for in test strips. Therefore, it may be necessary to talk to the insurance company before accepting a free meter from the doctor.
Be careful with some insurance companies and in some areas with the meters they want you to receive from medical supply companies. Often these meters are heavily promoted on TV and in magazines and some are not the most reliable. Some have annoying bells and whistles you don't need or will not use, some talk, giving you a vocal reading and if you are one that does not want others hearing this – forget these meters. Pain free meters don't exist and as one medical supply company advertises them as virtually pain free and you don't need to prick your finger. Unless you have forearms with no feelings or spots on you thighs that have no feeling then there will be pain. Also testing on your arms will give you readings that are about 15 minutes earlier and on your thighs that are about 20 minutes earlier than testing on your fingers. Why this lag time? Because you are testing from veins rather from your arteries. Review the part 2 of this series for less pain when pricking your fingers.
1. When accepting a free meter or shopping for a meter, consider these suggestions. Unless you are house bound, you will be carrying your meter and test strips with you wherever you go, so be sure that it has a good case.
2. Some people will look for a small meter, but this will depend on your dexterity.
3. The size of the blood sample needed is not as big a factor today as it was in the past, but still deserves some consideration.
4. Important for many people is the font size and screen brightness.
5. How long from blood wicking into the test strip to reading – should be five seconds or less.
6. Alternate site testing if desired – how easy is it?
7. Cost per test strip.
There are other factors, but they may not apply to you, but do your homework to know if your insurance covers the desired bells and whistles. That means you need to have a list of factors that you desire before you call your medical insurance company to know what they cover and will reimburse.