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Saturday, January 05, 2013

I'm a New Type 2. Do I Really Have to Test so Much?

I see that question a lot. 

The answer is no, nobody has to.   

But I believe it is wise to. Your meter, properly used, is the bright beacon that will light your way through the dark and confusing maze of food advice that bombards type 2 diabetics. You will get advice from every side. If you have not encountered the Food Police yet, you will. Expect to be told that you should change your diet in all or any of the following ways: low fat; low carb; lots of wholegrains; lots of fruit; vegetarian; vegan; raw; no red meats; avoid sweeteners; sugar-free; no dairy; add expensive herbs and supplements; the list goes on and on. What is right and wrong for you? Is no food safe?

Let your meter guide you to the answer. 

There is no doubt that the Test, Test, Test method is a lot of testing at first when compared with the minimal testing prescribed for type 2s by most doctors. But I believe it is well worth it. The investment of time and test strips in a concentrated effort in the short term has tremendous long term benefits that will last you the for the rest of your hopefully longer, healthier life. And, fairly swiftly, the need to test so much is reduced. The initial period is the heaviest testing load because at that stage you have a blank slate. As you fill in the blanks the load swiftly decreases.

I recommend the following intensive testing routine for people newly diagnosed with type 2 diabetes. It can also be very useful for those who have been diagnosed for a while but who feel they have "hit the wall" in their progress towards good control. 

For the first couple of days test fasting blood glucose (on waking, before breakfast) and also at one and two hours after absolutely everything you eat, unless you eat again before the second test. That includes breakfast, lunch, dinner and all snacks. This may help if you are not used to testing so much: Painless Pricks

Log everything on the menu including drinks, sides and portion sizes. Every evening spend a few minutes reviewing that log and use it to plan the following day's menu with a view to achieving better results. 

Some people are adamant that you must also test before meals. I agree that it may help to know the starting point when assessing a rise, but I do not think it is necessary to add an extra half a dozen tests every day to an already heavy initial load when the other tests will still achieve your goal. 

On the evening of the second day take some time to review all the results. Some of them will seem crazy, but you should see some patterns emerge. The first thing to look for is the timing of your most consistent peaks. That may be a little different for breakfast, lunch and dinner. Is it closer to one hour or two? If you can pick the most consistent peak time then replace the one and two hour tests with just one test at the peak time after each meal. If the peak time is unclear then continue to test at one and two hours and re-assess each evening until it is clear. If necessary add tests at 30 or 90 minutes to be sure; you won't need to do those for long.

Use of the peak post-meal time reduces your test load to fasting and peak time after every meal and snack. My own peak time is about one hour after my last bite, but yours may be different. Over the next few days, using this Test, Review, Adjust technique you should be able to discover several "safe" menus for various meals. You will also find that some meals are OK for the morning but not for the evening or vice-versa. Treat breakfast, lunch and dinner as quite separate results. 

When deciding your goals I suggest you start with the targets suggested in Test, Test, Test:
Fasting............................Under 110
One hour after meals.......under 140
Two hours after meals.....under 120

or for those in the mmol parts of the world:

Fasting............................Under 6
One hour after meals......Under 8
Two hours after meals....Under 6.5
Do not be distressed if your starting numbers are much higher. It took you a long time to develop your diabetes; you should not expect to correct those numbers overnight. 

Give yourself some time. It may take a few weeks, or even a few months, but the investment in strips and testing you make now will pay you dividends for years or decades. Eventually, when you find you can easily hit those targets consider revising them as I did. See my present targets at the foot of Test, Test, Test. 

Proceed cautiously if you use insulin or one of the insulin-stimulating medications. You do not want to go from hyperglycemia to hypoglycemia. Make modest adjustments to your carbohydrate intake, test the results and continue modest changes every meal until you achieve your goals. Eventually you may need to discuss reduction of your insulin or medications with your doctor as the numbers improve.

During the second week repeat some of those safe meals. Before your post-meal test try to guess what the result will be. If you can usually predict good results note that menu for future use; you will only need to test after that meal occasionally in future for reassurance. That removes another test from your day.

Gradually, over successive weeks, your knowledge of safe meals and food portions will grow and your need to re-test them will reduce. Fairly swiftly you should be able to plan menus that you know in advance will not cause blood glucose spikes; as a consequence your need to test so often will drop quite dramatically within a few weeks. Also, as my fasting blood glucose became fairly predictable I reduced that to just a couple of times weekly. 

You are building a database that is unique to you. I know it seems like a lot of effort at first, but believe me it will be worth it. 

These days I sometimes don't test for several days unless I am trying a new menu item or a new restaurant. If you have insufficient strips, time, or motivation to do it that intensively, that is OK. This will work too, but it will take a lot longer: Testing on a Budget

Cheers, Alan

Everything in Moderation - Except Laughter.