How Often Should We Test?

Over the past few years there have been some truly abysmal scientific research papers published on the futility of frequent self-testing by type 2 diabetics. Three that come to mind are The Fremantle Diabetes Study from Western Australia, Self-monitoring in Type 2 diabetes: a randomized trial of reimbursement policy from Canada; and Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial from the UK.

All of these papers have three things in common: they were published in countries where the government subsidises test strip supplies to diabetics, and thus has an interest in cutting health budget costs; they considered testing more than once a day to be "frequent"; and they did not educate the subjects being studied on how to interpret test results with a view to adjusting their lifestyle to improve results. I previously discussed the UK paper by Farmer et al in Self-Testing and Type 2 Management a year ago. Those same comments apply to all those papers.

The ignorance of the mainstream medical establishment concerning the benefits that can be gained from systematic self-monitoring of blood glucose appals me. Worse than that, many doctors and diabetes educators seem to feel that "obsessive" testing is much more dangerous to our health than the possibility of amputation, blindness or kidney failure so they actively discourage newly diagnosed diabetics from testing more than a couple of times per day - and usually only for fasting or pre-meal.

That fear of obsession is misplaced. I believe that it is partly due to two things. The first is the ignorant assumption that extra tests only lead to extra worry. My experience has been that, after newly-diagnosed type 2s discover that they can actually improve their test results by modifying their diet or lifestyle, worry is reduced. Action conquers fear. To me, the tests that lead to worry are those ordered by the doctors; the tests their patients do religiously for fasting and pre-meal that tell the patient nothing and that the doctor barely glances at during the next consultation.

The second reason is the equally ignorant assumption that those doing the extra tests will continue doing them frequently forever.

I always test with a purpose, to either learn or confirm knowledge. When I first read Test, Test, Test I put it into practice - totally. For a short period I tested before EVERY meal and snack, then at one hour after the last bite and then at two hours. On some days I tested over 20 times; that period also taught me how to achieve Painless Pricks.

But that was just the start. Very quickly I found that some tests became very predictable. I quickly dropped my pre-meal tests as unnecessary when I could predict them with good accuracy. Then, as I discovered that my own peak post-prandial time is one hour after I finish eating, I dropped the two-hour tests unless the one-hour was unusual. Within a couple of weeks I was testing fasting and my peak post-prandial after every meal or snack, usually 6-8 times daily.

With time those tests became predictable too, as I slowly modified my diet from disastrous (as taught to me by the dieticians) to low-spike using Test, Review, Adjust. Within a few months I was testing only 1-4 times daily.

Now that my personal data base of food BG effects is fairly comprehensive I only test for "maintenance", to check that things haven't changed. For several days I may not test at all, others I may test 3 or 4 times if trying a new recipe or menu.

I consider the invention and development of the blood glucose test meter one of the true miracles of modern science for diabetes self-management; a wonderful benefit for all diabetics. But, sadly, after over three decades of continual development and improvement of meters the medical establishment still has not come to terms with the correct ways to educate patients in their use.

Cheers, Alan
Everything in Moderation - Except Laughter

Past, Present and Future

When diagnosed with a serious chronic condition, it's a totally human reaction to immediately ask "Why me?" and to start reviewing all of the things that happened in the past to blame for this new affliction. We look for the cause. Was it lack of exercise, obesity, diet, genes or exposure to chemicals? Or was it unsafe work conditions, the government, alien experiments or cosmic rays? Who or what should we blame?

After a while most of us realise that the right people to ask those questions are researchers and doctors seeking new treatments and cures. But for the newly diagnosed diabetic, in the immediacy of deciding what to do now, those questions are irrelevant unless we are still doing whatever it was that was a problem.

When I got over the "Why me?" stage my logic was simple. Once I knew I had diabetes the past was irrelevant to me. I didn't care why I got it, I cared about what to do next.

I read everything I could find and understood some of it. My reading showed that several factors were likely to shorten my life or make it less enjoyable by causing complications. Among other things a few stood out: uncontrolled blood glucose, smoking, lack of exercise, obesity and poor nutrition. All of those were things I could change myself.

I also found from various scientific articles that these factors could be cumulative in their effect. Maybe not always for diabetes, but for long term health in other ways. And diabetes is not my only affliction.

Thus blood glucose control, while a priority, was not enough if I continued to be fat or smoke or be sedentary or eat poorly. Each was a factor, each unchecked could exacerbate the others.

I had ceased smoking the year prior to diagnosis but from that moment on I started acting on all of the other factors.

As I said, the past was irrelevant. Why I was now a diabetic was purely academic. What I was going to do about it was not. Focus on your future, not your past, and do things in the present to achieve the future you want.

Just my opinion.

Cheers, Alan

Everything in Moderation - Except Laughter.

The Price of Eating Healthy

Money can be tight in these troubled times of bank closures and uncertainty. As well as medical costs, this response I received recently when I suggested adding more vegetables and fish to a menu for a new type 2 is typical of many: "But eating lower carb versions of food is EXPENSIVE. I know some people say that eating healthy is not any more expensive than eating cheap but they are full of it."

I found that I actually saved money when we started "eating healthy". But I had to work at it, because it takes a little planning and effort. To start with, I ate less than I did in the past ; significantly less for some foods. That didn’t cover the higher costs of some new foods like asparagas, avocado and similar, but I certainly saved on breads, potatoes, corn, rice and similar starches. I also saved a lot on meat, by eating a lot less than I did in the past, and by not purchasing a lot of processed sauces and packet foods.

Money isn’t everything; there are other costs such as time. I accepted that part of the price for better health was a little more time spent in the kitchen. I write more on that here: Cooking as a Survival Skill

Thus, I accept some additional inconvenience. Cooking more at home also saves on the costs of eating out or fast-foods. It is always cheaper to cook at home even if you cook the same things as the fast-food places such as hamburgers or fried fish. But it does take more time and work.

However, there are ways to use time efficiently there too. Once I was already spending more time in the kitchen, I looked at ways of economising money and time. One major way to do that is to both buy and cook in bulk. An investment in a freezer and microwave will repay you many times over in being able to buy freezable ingredients in season when prices are low and store them appropriately for later use.

I buy meats and fish in bulk packs from the butcher. For example, I bought five kilos (11lbs) of rump (flank) steak as an uncut lump of meat from the butcher a couple of weeks ago. At home I sliced the premium parts, trimmed of fat, into a large number of small 100gm (4oz) steaks. I trimmed the scrappier bits and cut them roughly into 2.5cm (1") cubes for stews. I then cling-wrapped each individual steak and 1/2Kg(1lb) lots of stew chunks for freezing for future use. When I need a steak in the future it’s there in the freezer ready for me. Later I spent a Saturday afternoon cooking up stews, casseroles and soups in bulk, freezing the results in single-serve containers. When it comes time to eat those I've got a meal via the microwave in minutes that is cheaper, faster, healthier and tastier than anything from a restaurant. I do the same thing for fish, chicken and pork, waiting until "specials" appear for bulk lots, or a seasonal glut occurs, and purchasing then.

Many vegetables and fruits can be bulk cooked and frozen too. I buy (or grow) in season veges like tomatoes, silver-beet (similar to swiss chard, a good spinach substitute), sweet corn (I blanch and freeze 1/3 cob portions), string beans and several others. I buy mango, which can be very cheap in season here, or berries, and freeze those for later addition to home-made yoghurt. Some non-freezable veges can be stored longer in the fridge with little tricks like blanching.

As well as eating less I waste less. The change in the level of waste in our rubbish bin was quite dramatic when we stopped buying processed packet foods and also started being stricter for portion sizes; allied to that we are much more aware of separating scraps for the compost bin to help grow some of our own veges, another way to save on food costs for those with the luxury of some backyard or even planter pot space to do so.

We, as a couple, took the time to compare grocery bills from before my diagnosis and a couple of years later. Despite inflation, we were paying slightly less for our weekly food while eating healthier and tastier.

In the end, everything has a price. The cost may be calculated in dollars, health, time, or some other currency. What it boils down to is whether the goals we set for ourselves are worth the price. Each of us has to make that decision, but it helps if you truly calculate the cost.

Cheers, Alan
Everything in Moderation - Except laughter