April 4, 2014

SMBG Can Be Valuable for Non-insulin Type 2's?

On Monday, March 31, A.J. called and asked if he could come over as he had several things he wanted to discuss. I told him to come on and I would try to answer some of his questions. We talked briefly about some of the activities recently and then he asked me to pull up this article. His comment was that he had not seen me do any blogs from this source and I showed him two that I had already posted and several others that I have been working with.

When I went to open this blog, he asked me to wait. He said that does not have many readers. I said this is one of the things to expect when blogging. He asked me to scroll down the list of previous blogs and he said a lot of them don't have great readership. He said I have read every one, except for today's post, which I will when I am on the computer. I then brought up the statistics page and he said, “oh goodness.”
I said this is expected when people are not interested in something I blog about. Then I went to the audience page and he looked again and commented if it was not for other countries and the readership by them where would you be.

I said this is expected at different times when I write about topics that people are not looking for and have no interest. He said they are of interest to me and I generally find something that may apply in the future. He continued that he had a doctor's appointment earlier that afternoon and he remembered to silence his cell phone after reading that blog.

A.J. then stated the purpose of his visit and that he was very concerned about what the author had stated about there being no benefit for Self-Monitoring of Blood Glucose (SMBG) for non-insulin using people with diabetes. He continued that if he had not been on insulin and learned from the rest of our support group how to use his test results, he might have believed the article. He said that his insurance had limited him to one test strip per day, but he felt fortunate to be able to afford the extra test strips and felt that the investment was well worth the money.

A.J. continued that it was better than operating in the blind and not knowing where his blood glucose levels were at for different times of the day. I stated, let's take the three points and analyze them.

#1. In patients with diabetes who don’t require insulin, self-monitoring of blood glucose had a modest effect on HbA1c levels at six-months, which subsided after 12 months.

I asked him what he thought and he stated he did not understand. I said that the studies used only supplies meters and test strips with no education or minimal education. Once the study ended, no more test strips were provided. Okay, A.J.'s face lit up and he said now that I can understand. They would not have understood what they were looking at and have even less knowledge about how to interpret their readings. I then asked A.J. to read this blog. After he finished, he stated your last thought about why diabetes is then considered progressive really highlights their lack of education.

#2. Self-monitoring of blood glucose in non-insulin treated diabetics had no effect on satisfaction, general well-being or general health-related quality of life.

I brought this blog up and after A.J. read it, he commented that now he had a better understanding of why they could make stupid statements like this. Education is everything and the key to understanding SMBG.

#3. Supplies required for self-monitoring of blood glucose (BG) are more expensive than for urine testing, a common alternative for non-insulin treated diabetics.

Now A.J. was laughing. Peeing on a test strip is not very accurate and almost worthless. He said he had a friend that used them for another purpose, but had the guide for blood glucose as well and he had tested a couple. The color of the test strip was higher after the meal, but he had no true meaning for the result. If it had not been for his meter and test strips, he would still not know the true meaning of the results.

Then when A.J. read the paragraph after the three points, he stated how idiotic the studies sounded. This is the paragraph, “For type 2 diabetics who are not on insulin, monitoring their blood sugar does little to control blood sugar levels over time and may not be worth the effort or expense, according to a new evidence review.”

I asked A.J. if he had not curtailed the number of times he was testing now that he was off medications. He admitted that he had, but did test at least after the evening meal to know what his BG level was. He said he still keeps his food log and stress log and this helps him when his AM fasting test is high and the postprandial test was higher than he wanted.

Then A.J. asked why he did not remember my blogs and others that would help keep him from being so concerned when he read articles like this. I said because he is only reading and not writing blogs.

We talked for another 30 minutes and he asked to read several of the other blogs the search on my site had collected. When he came to this blog and then read a link in it, he said this even gives more of a reason the discredit the Cochrane Review. I said they still like to trot this out every few years and make their pronouncements. I said there are just too many pieces of information that they leave out.

A.J. said it was time to get for home and eat, but he thanked me for giving him something to think over.

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