April 17, 2016

Testing to Manage Your Diabetes

If you have diabetes (any type), testing your blood glucose should be a part of your life. The test results will tell you and your doctor if your diabetes is well managed or not. The fallacy of this is that most doctors do not even look at your test results, but instead rely only on the HbA1c test they take.

This means that many people with type 2 diabetes especially, will need to learn how to interpret their test results and obtain copies of their lab results for comparison purposes. The WebMD article states that you and your doctors will work closely together to find the answers that will keep you healthy. For people with type 1 diabetes, this is probably true, but for people with type 2 diabetes, most doctors follow the ADA. They won't even prescribe the testing tools as they have been taught by the ADA that you are supposed to rely on the A1c results and not test.

This means that people with type 2 diabetes are operating in the dark about care for their diabetes and are not able to learn what foods or types of food raise their blood glucose levels dramatically and need to be eliminated from their food plan.

In goal setting, you’re aiming for an A1c level of 6.5% or less, which equals an average glucose (or eAG) of 140 mg/dl. Your doctor will give you an A1c test every 3-6 months.

When you should test and what goals you’re aiming for depend on:
  • Your personal preferences – but testing should be before and after meals for 3 to 4 months after diagnosis – called testing in pairs.
  • How long you’ve had diabetes.
  • If you’re pregnant.
  • Your age.
  • Other health problems you may have.
  • Medication(s) you’re taking.
  • If you have complications like retinopathy or neuropathy.
  • If you have low blood sugar (your doctor may call this hypoglycemia) without warning signs.
As mentioned above, testing times after diagnosis are important to help you establish a food plan and track what the different foods do to your blood glucose levels. You will also need to check the components of lifestyle change in my blog here, to determine the lifestyle changes you need to make.

A fasting blood glucose level, taken in the morning before you eat or drink anything, is the go-to test for many. Another test at bedtime is common. But what about other times? Testing 1 to 2 hours after breakfast or before lunch gives a more complete picture of what’s going on, says Pamela Allweiss, MD, of the CDC.

“Testing is really important, particularly if you take insulin or medicine that can cause hypoglycemia,” says David Goldstein MD, professor at the University of Missouri School of Medicine. And measuring both before and after meals is important in understanding what your blood-sugar patterns are and what to do about them.

This switch is part of a move away from a kind of one-size-fits-all thinking and toward more individualized care. Why? The old mantra was that better control led to fewer complications, Allweiss says. And that works OK for people who are healthy despite the diabetes.

In addition to understanding why you are testing, the following is important. All this testing means nothing if you don’t keep track of the results. Many glucose meters now do that for you. You should also keep a log. A full lifestyle diary that includes your eating and exercise habits, and how you feel at different times of the day, can also be a big help.

There’s lots to self-monitoring of blood glucose and lots to learn. Your self-testing is a big part of it. One number doesn’t tell the story. Looking for trends is also important.

A number by itself is just a number, Allweiss says. “We want to look at a pattern.” The steps to take after testing, of course, are simple enough. Talk to other people with type 2 diabetes and learn what all those numbers mean, and figure out how you can meet your blood glucose goals.

Diabetes requires a lot of education. It isn’t like taking a pill and seeing a doctor twice a year. You have to be engaged,” Goldstein says. We have great tools now, and we need to teach people how to use them. People have to know what to do -- and then they have to do it.”

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