January 10, 2013

Tips for Glucose Testing – Part 4

Part 4 of 4 parts

Financial Assistance
Those that have insurance or Medicare generally will not have problems with testing supplies, other than not being reimbursed for enough testing supplies. Not having insurance can create problems and needs answers. Getting free meters is not the problem; check the last paragraph of the Diabetic Connect article. That is still not a good answer, as it is the test strips that cost and without insurance, be careful. A free meter with expensive test strips is not a solution.

Ann Bartlett has an excellent blog on Health Central about finding financial assistance. It is over a year old, but is still good information. She also suggests talking to your pharmacist and it is possible that the pharmacist may have some suggestions that will be of help. Although this is now over two years old, there is some excellent information on test strips and meters, especially about where to find them. A price check on Amazon dot com can confirm prices of today.

Another alternative is to find some manufacturers and check their web site for assistance programs. You will need to follow their directions, but most do have fairly good programs.

Amy Campbell has an excellent blog on Jan 7 at Diabetes Self-Management on "Know your health plan," that covers many areas that I did not.  Dealing with most medical insurance companies requires every bit of help you can get.

Exceptions in Blood Glucose Testing
When doing blood glucose testing, there were some ideas that I did not want as part of the normal testing and I will discuss them here. The first is controversial, many can find no logical rules for it, and others say it does not exist. Most discussion happened prior to five years ago, but you should be aware it. The Somogyi effect, also known as the “rebound” effect", was named after Michael Somogyi, the researcher who first described it. It is caused by the tendency of the body to react to extremely low blood sugar (hypoglycemia) by overcompensating, resulting in high blood sugar. For many people with diabetes this does not happen because these hormone regulators are not functioning properly. For some people in the early stages of diabetes they can work - as when blood glucose levels drop too low, the body sometimes reacts by releasing counter regulatory hormones such as glucagon and epinephrine. These hormones spur the liver to convert its stores of glycogen into glucose, raising blood glucose levels.

Often the effect is mistaken for the dawn phenomenon (DP) when the liver dumps glucose to start the wake up process. People have been checked with continuous glucose monitors to prove whether it is the Somogyi effect or DP. The dawn phenomenon is much more prevalent in people with diabetes than the Somogyi effect.

The other problem is what people eat. People that eat a higher percentage of fat can develop the pizza effect for testing. This means that their blood glucose high level will not happen often at the two-hour point, but can happen between the two hour and five hour marks. This depends on the person's body and how much fat is consumed. The pizza effect got its name from those that had pizza for a meal and wondered why they were still low at the two-hour mark, but later were much higher. Therefore, when you eat pizza, do not be surprised to find a high level of blood glucose at a later time than you normally would and the same can hold true if you have any other high fat meal. Fat slows the digestive process and thus the release of glucose into the blood.

Understanding Self-Monitoring of Blood Glucose (SMBG)
SMBG is just what people need to learn to assist them in managing their diabetes. In addition we also have available to us diabetes self-management education (DSME) and diabetes self-management training (DSMT). These two are discussed in this blog and this blog. These are written primarily for the elderly, but may be adapted to the younger people.

I have stated this before and it is so true. “Each person has to learn about how their body reacts to diabetes, how much exercise they are capable of doing, and finding out what works for them. There are no firm rules other than what works for me, may not work for you. Much of what is taught is on a one-size-fits-all basis, which can be misleading for many and does not work for everyone. This is the reason for giving people other information so that they may try different approaches in finding what works for them.”

Even if this is not within SMBG, it is important to say that experimenting is allowed and encouraged to discover the best management of your diabetes. Never be afraid to take a one-size-fits-all point and adjust it to fit your needs and what works for you. Yes, I make a lot of fuss about one-size-fits-all discussions, because many times it is written as if this was the only right way to solve the problem. I have found through experimenting that what is written to be the only way is wrong and adjustments can be made and still have success.

This is why some bloggers write about SMBG being so important. I have found out that being my own lab rat has been beneficial and why testing has become so important to me. This has allowed me to become more efficient in managing my diabetes. Am I a model of perfection? No, I can still do things incorrectly, but this also teaches me what works and discover why some attempts fail. I use my testing records, food log, and daily health log to see patterns developing. Then when I get the results of the tests the doctors order for me, the light often comes on and, yes, I can see why something is improving or going in the wrong direction.

I always feel good when things go right, but I have found that when I make a mistake, sometimes they scare me, but by using them as lessons, I am able to continue to improve. Please take time to read several of my blogs on SMBG – blog 1,and blog 2.

Even though this blog was written with tongue-in-cheek, this is something that I have encountered, as have others of my friends. We need to be careful in what we accept as being the best for us and realize that some of the people that are to be considered as resources, often make it more difficult because they don't understand us. Others do and can help us.

No comments: