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Wednesday, July 30, 2008

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


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Darryl said...

Thanks for sharing your experiences - they will help me to decide how to respond to the doctor who scribbled on my prescription request "should only be using (test strips) when feeling unwell".

daniel said...

You wonder what sort of dietary advice was given, when the decrease in a1c was so poor