Have Diabetes; Do You Eat to Your Meter?

Many people do not eat to their meter. Why won't they at least do something to make it easier to manage their diabetes? Here are some of the excuses I hear:

1. The doctor doesn't want me to test.
2. The cost is too high.
3. I forget to test too often.
4. I am not that interested.

My feeling on this is you are not concerned about your health and are not taking your diabetes seriously. That being said, I have met a couple of people that could not find the money for testing and for that matter even their medications. Both did afford shelter and most of the food they needed. They lived on very limited income, did their own cooking, and stretch their money very well. Several of us did write some testing supply companies and the companies for their medications.

The doctor for one of the individuals would not support the request for testing supplies and this prevented her from obtaining them. It took convincing her to change doctors that finally got her the testing supplies. The doctor was highly put out and told her that the ADA advised using the A1c only and she did not need to test. He even continued trying to block her obtaining testing supplies until someone asked her if she had been in the military to which she answered yes. Once we had her apply for benefits and they looked at her income, she will received all her medications and testing supplies for no copay.

We talked to the other individual and he said his doctor had asked him the same question and when he said yes, he had been sent to the local VA office and was also receiving his medications and testing supplies for no copay.

Both are testing more frequently and are trying to eat to their meter now and like both have reassured us, they are bringing their A1cs down into the 5's and one hopes to be in the 4's by the next A1c. Both are happier and thanking those of us that helped them.

I would urge anyone to read this by Kelley Pounds on “eating to your meter.” It is more complete than many other sources.

The best selection from her blog is this - “If you have diabetes, you may also be familiar with the ADA (American Diabetes Association) targets of less than130 mg/dl pre-meal and less than 180 mg/dl post-meal. PLEASE DISREGARD THESE TARGETS. These targets WILL NOT protect you from serious diabetes complications. Just because these are considered “average” or “normal” diabetic blood glucose levels, it is also “normal” for many with diabetes to develop heart and kidney disease, strokes and undergo amputations. These are considered just part of the “normal” progression of diabetes by organizations like the ADA. PLEASE, disregard these targets!

So let’s review:

Normal BG: Pre-Meal – less than 85 mg/dl, Post-Meal – less than110 mg/dl BEST

AACE Targets: Pre-Meal – less than 110 mg/dl, Post-Meal – less than140 mg/dl ACCEPTABLE*

ADA Targets: Pre-Meal – less than 130 mg/dl, Post-Meal – less than 180 mg/dl UNACCEPTABLE

*Acceptable - as a starting point for those with advanced diabetes. This should be the maximum acceptable blood glucose level for those with diabetes.

So, if you look more closely at these targets, notice that this leaves you NO MORE than about a 25 point spike in blood glucose to maintain normal blood glucose and NO MORE than about a 30 point spike in blood glucose to maintain “diabetic normal” blood glucose. We will discuss the ADA targets NO MORE.”

Eating to Your Meter

I know you have heard this or eat to your meter. Many people with diabetes refuse to do this and often wonder why their blood glucose readings are remaining elevated. Their doctor sees A1c's that are elevated also and asks what they are eating. Many just don't answer or give what they know they should be eating and the doctor has to assume that their pancreas is not producing enough insulin or that the patient is very insulin resistant.

Yes, more test strips than your insurance will often allow, but if patients are honest with their doctors, and request extra, many doctors will go the extra mile and request the insurance company to provide more for three to six months. Some insurance companies will allow this if they see the A1c's coming down, as they don't want the extra expenses involved with complications.

This is one reason I suggest food logs be maintained as well as blood glucose reading logs. This means extra work and many people with diabetes don't see the value. I say that anything that can help manage diabetes and prevent complications is worth the effort. Life should slow down and people should take the time necessary while eating or immediately after the meal. People can forget an hour later and this robs them of the information that could be of help in determining if they need to reduce the quantity or eliminate a food item from their meal plan.

If you can afford the extra test strips, use them wisely. Continue the testing as soon as your wake up (fasting blood glucose reading) to watch for trends. Then select the meal that is generally your largest meal. Always test before the meal to give you a base for the after meal readings. This is just a suggestion, but after first bite, I start testing at the one-hour mark and test every 15 minutes until the next reading is less the previous reading. I do this every day for a week and then every few months (normally three or four months) until I am comfortable that the time was staying consistent. For me this was about 90 minutes, that was until I started slowing my eating and chewing my food longer. Then the time changed to 75 minutes.

Others that I know start testing at the one-hour mark and test every 30 minutes. Most end up at or near the 85 to 100 minute mark. That is why we tell people that what works for me, may not work for you or your mileage may vary (YMMV). Some people start testing one-half an hour after last bite. The best method is being consistent with when you start testing and the testing interval.

Now, realize that you are measuring the difference between the before and the after meal tests. Most people do not want an increase of more than 40 mg/dl. There are also people that want even less of an increase. We can use this information to determine if we need to curtail the serving size of food we eat, or if this is something we need to eliminate from our food plan. Many people strive to have premeal (preprandial) levels of 80 to 90 mg/dl and post meal (postprandial) levels under 125 mg/dl.

By doing testing, you will often be surprised what can be eaten with a smaller serving size and by counting carbohydrates.

The biggest problem is balancing the nutrition to obtain the nutrients you need including vitamins and minerals. Realize that I am not referring to whole grains which we can live without as the nutrients can be found in other foods that do not spike blood glucose levels as whole grain foods do.

Is There a Best Way, Part 5

This is almost a repeat of a blog I did back on November 9, 2011, but I hope that I have a few new thoughts of benefit to my readers. For those with type 2 diabetes and on oral medications, affording the extra test strips may be a hindrance, but if you are able to afford them you will be better off if you are having problems managing your diabetes. Therefore, most of this is aimed for people newly diagnosed or recently diagnosed with type 2 diabetes whether you are on oral medications or on insulin.


Eating to your meter shortly after diagnosis is very important. We have all read this, but have you really tested this? Eating to your meter can be very beneficial in helping you manage your blood glucose. For those with type 2 diabetes and on oral medications, this is a philosophy you almost must adopt to manage diabetes effectively. Counting carbohydrates is even more important so that you learn how to manage the food intake to get the greatest efficiency from your diabetes medications.


Even being on insulin this is important to make your diabetes management more effective and hopefully reduce the amount of insulin you will need to inject. The medications you are taking will only manage so many carbohydrates effectively and then you start to lose control. This then becomes more important to know what your blood glucose meter is telling you about the quantity of food you consumed. Using your meter also can indicate which foods you need to severely limit and which you can consume or may need to eliminate altogether from your menu.


Most of you will probably need to have a good discussion with your doctor about the number of test strips your medical insurance will over. Most doctors are able to write a letter that will get coverage for extra test strips for up to six months before the insurance will stop covering them, but not Medicare. The important discussion with your doctor is the reason and length of time you want the extra test strips. Extra test strips may not be available if your doctor will not write a letter to your insurance company. Occasionally, you as the patient will need to make a call to your insurance to negotiate for extra test strips. It would be in your best interest of diabetes health to make the plea to your insurance company.


On limited test strips, eating to your meter may be very discouraging because you do not have a lot of information to guide you. That is one reason, I suggest that if you can afford it for a few months, buy extra test trips. The extra testing supplies will give you confidence in your carb counting and portion of food intake. It will also make it easier to determine what foods are best left off the menu.


There are various plans discussed for those on limited test strips so you will need to work with what works best for you. A food log after diagnosis is also an aid that many people just do not understand the need to keep. I can attest to how many times this has told me why my postprandial blood glucose levels were higher than they should have been and what I did not do. The important part is not lying to yourself, but keeping accurate logs. I record my log at the end of each meal and record the carbohydrate count before starting the meal.


Knowledge is power, and therefore knowing what each test is telling you, watch for trends in fasting blood glucose levels and use your meter to learn more from pre-meal testing to tell you about your prior meal. If you can afford extra test strips for a month or two, learn that you do not want your pre-prandial and postprandial readings to increase more than 40 mg/dl if possible. You should also develop an exercise regimen with your doctor's approval to help get your blood glucose numbers to become the best for you.


If you do have trouble with managing your blood glucose levels, give insulin a consideration and study about it before the need arises.


Read a couple of other articles about eating to you meter here and here. Before reading the second article, please locate this conversion chart and page down to glucose. For many of the readings you will need to divide by the conversion factor.