Must I test Before Meals Too?

Over a decade ago I learned this advice from a wise lady named Jennifer: Test, Test, Test. These days I endeavour to pay it forward by passing that on to every newly diagnosed person I encounter who is prepared to read it or listen to it. In that respect I am a testing evangelist ‘spreading the word’ although I do not press the point if the person does not want to hear it. My reasons are simple: twelve years later I am still awaiting the development of complications. When I look back to the day I first read it in 2002 I am quite convinced reading those words saved my life. 

Not all want to hear it, nor do those who do always accept it.  By far the two most common reasons for resistance are inconvenience and cost of the initial level of testing. Although I do not consider it a high level of testing new people do because their doctors either did not recommend testing at all or suggested only once or twice a day. Although my usual response to those objections is to point out everything has a price and failing to test sufficiently now may have a much higher health cost in later years, I fully accept that both points can be valid for individuals.

If the new type 2 diabetic leads a busy life, at home or at work or both, it can be a major inconvenience to put everything on hold for five minutes one and two hours after every meal. Add fasting and bedtime tests and you have a minimum of eight tests per day, more if snacks are included. That is swiftly reduced when discovery of the post-prandial peak enables reduction of post-meal tests from two to one, but that is still five to eight tests daily. Personally, I tested up to 20 times a day in that first week but I had the luxury of being retired at the time with government-subsidised test strips.

The good news is that such a high level of testing is not necessary for very long as the personal food-effect data-base grows from the results. I discuss that in detail in I'm a New Type 2. Do I Really Have to Test so Much? But for a new person the initial high testing load I suggest can be quite daunting.

The other objection is also valid for many. In some countries test strips can be either very expensive or restricted in prescribed quantity for type 2s by insurers or misguided doctors. When it can cost up to a dollar a test, ten tests a day can be a very significant drain on a limited budget. Some solve the problem by buying less expensively on the web, with associated risks including possibly dishonest suppliers and passed expiry dates; others search for the cheapest meters and strips available to them. Some of those can be good (I read good reports on forums about the Walmart Relion, but I have not used it myself) but in general ‘you get what you pay for’ tends to be true in any marketplace.

Those are the reasons I wrote Testing on a Budget. The method works less rapidly, but it still works eventually and uses a lot less strips.

With that background I quite deliberately choose not to recommend testing before meals to newly diagnosed people. Persuading a new person to test whose doctor did not even suggest a meter is hard enough, persuading them to test as Jennifer suggests is more difficult. Adding even more tests before meals can be pushing the envelope too far.

Those who promote testing before the meal tend to ignore that aspect. They suggest testing after meals is a waste of time if the person does not also test before the meal. Their logic is that without the pre-meal test the rise in blood glucose caused by the meal cannot be accurately known. That last part is technically true but I do not think it is of sufficient value to add those tests to the load. Knowing the trends for the actual peaks reached, without knowing the pre-meal base levels, was quite sufficient for me to swiftly modify my menu for good post-meal blood glucose levels.

Pre-meal testing adds three to five tests daily to the high level of testing I suggested. As I mentioned earlier my primary reason for not recommending pre-meal testing is that it is difficult enough to convince newly diagnosed type 2s, shocked and scared from their diagnosis and nervous about poking holes in themselves, to test peak-post-prandial at all when the doctors do not prescribe it. It is even more difficult to convince them to do it as often as suggested in Test, Test, Test or Test, Review, Adjust. My first aim is to persuade them to do that much. Adding even more tests to that advice can be counter-productive.

A motivated minority follows the pre-meal testing advice but, sadly, being told to add even more tests is the last straw for some. They revert back to the ‘test fasting and pre-dinner, if at all’ advice they heard from their doctor and drop the idea of post-meal testing altogether.

In my own case I tested pre-meal a few times in the first couple of weeks but soon found those tests became boringly predictable, apart from the odd crazy result. Later I started to understand why some of those results weren't crazy. Many factors, not just food, affect the pre-meal level: dawn phenomenon or liver dumps; exercise; stress; other medical conditions and medications; infections and illness; or excessive time since the last meal to mention just some. The same carbohydrate input at the same time of day may cause quite different rises if the pre-meal test was affected by those factors because the ingestion of the food may cause other reactions in the body as well as some becoming blood glucose. As a personal example I suffer from dawn phenomenon. My post-breakfast one-hour level is often lower than my fasting level because the low-carb meal stopped the liver dump without adding to the load.

More significantly, I found that my trends for the post-meal peak after identical meals at the same time of day were remarkably consistent regardless of the pre-meal tests. The delta or rise was sometimes very different, but the absolute level reached was rarely off the trend line. Try it yourself to see. My logic is if I reach levels I do not like, such as 10 mmol/l (180 mg/dl), it didn’t matter much whether I started at 5 (90) or 8 (133) – I still went too high and I should review the menu. Following that logic worked pretty well for me. Minor variations are ironed out as I do not base decisions on one test but on the trending effects of many.

I do not use insulin or an insulin-stimulating medication. For those that do, your doctors or educators will advise whether pre-meal testing is necessary to calculate doses. That is a quite different reason for testing.

If you have the time, motivation and cash to support pre-meal testing as well as one or two tests after every meal, plus fasting and bedtime, do it. But I see no need to, especially in the first few weeks.

For the rest of us I consider pre-meal testing to be usually a waste of a test strip unless it was prescribed by your medical advisor for their information. The only time I test pre-meal apart from my pre-breakfast fasting is occasionally an hour or two after lunch or dinner to see if I can have a dessert. If I am high, the answer is no. If not, I might indulge in a treat.

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter