August 9, 2016

The Value of SMBG Testing – Part 3

I like the last paragraph and sentence in Gretchen's blog in the referenced blog, as I can agree with this. I would like to see the use of the continuous glucose monitor used for a minimum of 4 months after diagnosis.

I think every type 2 should be provided with a continuous monitor for the first 2 or 3 months after diagnosis. Then they could switch to test strips and intensive testing for the next year, and finally to testing only for new foods, sickness, new lifestyle patterns, or when they felt something was not right.

Test strips are much cheaper than dialysis.

The purpose or goal of SMBG is to collect information about blood glucose levels at different times during the day to assist you in creating a more level blood glucose. You will use this information to adjust your regimen in response to the blood glucose values. This will mean adjusting your food intake, physical activity, and possibly medications with your doctor’s direction.

SMBG can aid in diabetes control by:
  • facilitating the development of an individualized blood glucose profile, which can then assist health care professionals in treatment planning for an individualized diabetic regimen;
  • giving people with diabetes, and their families, the ability to make appropriate day-to-day treatment choices in diet and physical activity as well as in insulin, oral agents, and even no medication;
  • improving patients’ recognition of hypoglycemia or severe hyperglycemia; and
  • enhancing patient education and patient empowerment regarding the effects of lifestyle and pharmaceutical intervention on glycemic control.

Patients properly educated and with some experience with SMBG can benefit from the empowerment that SMBG bestows. Diabetes specialists believe that patients should use the SMBG data for daily regimen changes and health care professionals should use SMBG data to guide changes in medication regimens.

The use and frequency of SMBG is the area of much disagreement among the various specialists and advocates of SMBG. From my prospective, I feel it will depend on what your budget allows and insurance will cover. With all that is happening with studies it is surprising we still have testing supplies. Some doctors will not even give prescriptions for testing supplies and others will delay this until the patient insists. Most insurances will cover a meter and test strips up to what Medicare allows for the type of diabetes you have and the medication you are taking. SMBG is the battleground for all people that need testing supplies. Medicare restricts testing supplies and most insurance companies follow in lock step.

If you are able to afford additional testing supplies, by all means, make good use of them. Shortly after diagnosis, you need to use your meter to determine how different foods affect you blood glucose. This will assist you in knowing which foods to decrease in quantity, which to eliminate from the menu for now and which are safe to continue eating. Most people that are conscientious about their testing and realize that readings are trending upward will want to retest their foods again and find out what is changing.

We all need to understand the reasons for doing certain tasks and the more we understand about self-monitoring of blood glucose, the more effectively we will use it. I am not in agreement with the current trend in testing for people with type 2 diabetes. The powers that be just do not allow for proper testing or frequency of testing needed to cover periods when your body chemistry may change, for determining what foods do for your blood glucose levels, whether an illness is affecting your blood glucose, or if a medication, especially steroids, is driving your blood glucose above normal levels. These are concerns all insurance companies do not even allow for. Even our medical community shows little interest in this and will deem you to be not watching your blood glucose when your A1c rises unreasonably.

For patients with type 2 diabetes, optimal SMBG frequency varies depending on the pharmaceutical regimen and whether patients are in an adjustment phase or at their target for glycemic control. If a patient is on a stable oral regimen with A1c concentration within the target range, specialists recommend infrequent SMBG monitoring. In such cases, patients can use SMBG data as biofeedback at times of increased stress or changes in diet or physical activity.

Just remember that in testing at the beginning, you use “testing in pairs.” This means before eating and one or two hours after eating. This will tell you if the food combo you are eating is driving up your blood glucose and whether you need to reduce the quantity you consumed or possibly eliminate the combo completely.

If you have diabetes, you have responsibility in your medical care. The role means self-monitoring of blood glucose to manage the health you have. I find that managing diabetes is challenging. It can be a burden, but only if you let it. There are enough challenges to keep a person reaching for that higher level of diabetes management. One thing for all of us to remember is the importance of a positive attitude. This will generally help us through the tough times and keep us motivated to stay on top of our efforts to manage our diabetes.

With type 2 diabetes, our care may be sporadic from our health care providers and since they do not live with us 24/7. it is urgent that we learn how to care for ourselves. Is this easy at the start? I would be lying to myself and to you if I said it was, because there are many things to learn. It does get easier and at the same time more frustrating as we learn more about diabetes and its idiosyncrasies. We have to learn how to manage diabetes without assistance on many fronts.

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