AAFP and Their Professional Website – Part 1

Part 1 of 3 parts

When I started reading this, I had some very mixed thoughts. Normally I would not even refer you to this, but I feel some education is in order. You need to understand why sites like this can be loaded with poor or incomplete information. This website is the example of incomplete information. Some of the information is good, but in my opinion, it does not out weight the incomplete information. I even had to do a double take when I really looked at the site for an address. It is on the American Academy of Family Physicians (AAFP) website. And yes, I stand by my statement. Some information I consider critically incomplete and some is just in the way a patient views it, or has learned it. This can happen in any medical information.

Yes, I do not like it when a professional organization chooses to ignore good policy when it is available and leave out important information. It would have been wiser of the AAFP to refer readers to other sites instead of leaving information out. They also do not update the information on a yearly basis. In some instances, this creates what I would term a fatal lack of information. Information changes rapidly and to not update the website is not a good promotion of their profession. Even the ADA issues new guidelines every year, faulty as they are.

At first I was attempting to do a blog for each topic or in some cases two or more blogs, but this would result in too many blogs. Therefore, I will try to limit the number of blogs and just highlight the incomplete areas and the areas I find that are critical errors. I will start with the critical errors.

I do not understand the reasoning when they say, “The other test is called SMBG, or self-monitoring of blood glucose.” This is stated here and here. Yes, I can understand how some people may think this is the test, but this is not the way I was taught.  Many people are just told to test and to consider this SMBG, but are told nothing more about SMBG.   I admit I know a fair amount about SMBG and have blogged about this quite frequently. To me SMBG is the process of using the blood glucose test results (not just one test) to monitor how well, or not, you are managing your blood glucose levels on a daily, weekly, and continuous basis. The test is done with the blood glucose meter and test strip. Then the meter translates the results from the test strip to a reading on your meter that we can all understand.

SMBG is the process of using the data from the different tests to look for trends and other relationships. SMBG should teach you the when, where, why, and how of testing for you to manage your diabetes more effectively and efficiently. We look to the food we have consumed from our food logs, how we feel from a health standpoint (our health logs), and the time of day. Then we analyze the test information to see if we are on target, or need to reevaluate what we eat and adjust to be on target for the next test. This will help us determine if we need to do more exercise, or if it gives us clues about our health care we may have missed.

This is the second critical error. And yes, I am being technical here, but the doctors or writing staff of the AAFP does not seem to want to use the correct terms. There are blood glucose monitors, but this is for having a device (canula) inserted under your skin and this reads the interstitial fluid glucose levels. This device is called a continuous glucose monitor (CGM). Even they cannot be relied on for obtaining blood glucose readings that are current. They have a lag time or time difference when compared to a blood glucose meter. They are excellent tools for determining trends and giving you an idea of where you were about 15 to 20 minutes ago. CGM devices measure glucose levels in interstitial fluid in 1- or 5-min increments (depending on the system used) on a continuous basis.

For most testing, we as type 2 patients use a blood glucose meter. Now if we have a glucometer, then we know the brand of our meter and that it is a registered trademark of Bayer. If you think the doctor is prescribing a blood glucose monitor, make sure that it is a CGM and that your insurance will cover it. Most insurance will not cover a CGM for patients with type 2 diabetes, as they are expensive. It may be easier today than a few years ago, because some doctors are more persuasive in their writing ability and doctors generally prescribe these only for type 2 diabetes patients that are unable to manage their blood glucose levels. Chances are that it is a blood glucose meter he may prescribe, but if the doctor is an owner of Bayer stock, it could be a glucometer.

The third critical error is here (at How can I deal with an insulin reaction?)  The AAFP says people who have diabetes should carry at least 15 grams of fast-acting carbohydrates with them at all times in case of hypoglycemia or an insulin reaction. The list is far from complete, the fastest carbohydrate tablet is about 4 grams each, and 5 grams are very uncommon, although some may exist and it may depend on the area of the country. Many people that have hypoglycemia problems have bottles of them. In checking with my local pharmacy, they carry tubes of 10 tablets of 4 grams of glucose in the various fruit flavors. They can get the 15-gram glucose gel tubes and bottles of 50 each of the 4-gram glucose tablets. I still have two strips of three each of the 15-gram glucose tablets. A person with type 2 diabetes on most oral medications may not need more than a tube or 40 grams. Anyone on insulin needs to have more glucose tablets available. Apparently, this is another area where they need to update to reflect what is available and specify the instructions for type 1 or type 2 (for oral medications and insulin) patients.

If you are a person with type 2 diabetes having problems managing your blood glucose levels and have been prescribed a CGM, then you will also need a meter for times when you are experiencing hypoglycemia. You will need the now factor for blood glucose testing. The lag time on a CGM may cause you real problems, which you do not need during a hypoglycemic episode. Not being able to adjust quickly enough can put you into a coma. If no one is around or you live alone, people have died.

The next critical error I feel needs mentioning is the list of quick energy sources for correcting hypoglycemia. The AAFP just listed some of the sources of quick energy. Then they list milk without specifying non-fat milk. Fat will slow down the speed needed to bring blood glucose levels back to near normal. I would encourage you to compare the AAFP list to this list from cardiosmart.org as well as the information with it.

The last critical error is the mixing of information for type 1 and type 2 diabetes. There is much information that can apply to both, but also a lot of information that needs to specify whether they are writing for type 1 or for type 2 patients.

Knowing When to Test Post-Prandial

When do you test your blood glucose after a meal? Many people do it at one hour and others do it at two hours after eating. In my reading and experiences, either may be correct and either may be false. It is for this reason I encourage people to find their own post meal high point in blood glucose levels. Since there are so many variables involved, you need to find out what is best for you. Not every day will be the same or every meal.

Rather than repeat what other excellent bloggers have written, I will refer you to their blogs. Tom Ross has three, one here, and the addition to it here, then he had a surprise (these do happen) and has a blog here. Yes, we do correspond about these topics. Alan Shanley has two blogs on the topic with a different perspective here and here. I have written a blog on what your meter tells you about what you eat. Even Will Dubois has a blog post related to meters and their importance – meaning testing..

Cannot afford the extra test strips, then you may need to talk to, or write your test strip manufacturer, and see if there is any assistance available. You may be surprised. I am aware of one enterprising young woman that was able to get a vial of test strips just by asking and explaining why and for what she would be using them. Do not expect to be as lucky as she was, but in her case, she did have a need. Some manufacturers have assistance available to obtain them at reduced cost. There are different organizations available on the internet, but I urge caution in dealing with some of these. They overcharge and often send out out-dated test strips. Check this out for avoiding some of the problems.

If you can afford or get extra test strips, learn your time of high blood glucose levels post prandial. Also, use the extra test strips to find out how the different foods affect you. Use the extra test strips wisely in your own lab. Find out what the different foods do to your blood glucose. Do take time to study the glycemic index tables for foods. Do not believe these are gospel because the index is determined by testing normal people and not people with diabetes. Do use it only as a guide for determining which foods may rapidly raise your blood glucose. Here is one small table and by using your search engine, there are many available (key words – glycemic index). Table sugar has a glycemic index of 80, so compare that to the white potato.

Some people are able to eat potatoes without a high spike in blood glucose while others are able to eat rice without a high reading. If you do not have problems with grains or celiac disease, whole grains and foods with whole grains may cause high levels. So be prepared to find out whether you are able to consume them or able to have a small serving. I can eat certain types of potatoes and most rice (at separate meals, of course) without a high spike, but if I eat any whole grain or even refined grain products, and look out high blood glucose levels. I also limit the amount the above foods accordingly to prevent unnecessary spikes above my limit.

Too much of any food with carbohydrates can cause blood glucose levels to rise higher than desired. So test to see how they affect you. Every person is different and can be different at different times depending on the combination of foods consumed. As you find out which foods cause you to spike, decide whether to eliminate them from your menu or reduce the amount consumed. Be careful of many fruits and certain vegetables and eat them in moderation.

Now, find out the average time from first bite, or last bite, (your choice) to your high level, but be consistent. Some of us learn to do it one way and there is some confusion, but select one method and stay consistent in using it. Once this is determined, be ready to do more testing. This is not a precise science, and that is why each individual needs to do their own testing. Yes, you could be one of the lucky ones and make all the right guesses, but I urge you to do this about once a year to see if something has changed. Definitely consider this if you know things have changed. And be aware that there can be surprises. This can negate your confidence in your testing method, but please do not let it.

Good testing!