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. 

The Fat Tax: Dare I say I Told Them So?

I am flat out preparing for departure on my Myanmar trip tomorrow but I could not let this news item pass unnoticed:

Denmark to scrap world's first fat tax

"The fat tax and the extension of the chocolate tax - the so-called sugar tax - has been criticised for increasing prices for consumers, increasing companies' administrative costs and putting Danish jobs at risk," the Danish tax ministry said in a statement.

"At the same time it is believed that the fat tax has, to a lesser extent, contributed to Danes travelling across the border to make purchases.

"Against this background, the government and the (far-left) Red Green Party have agreed to abolish the fat tax and cancel the planned sugar tax."

I wrote earlier on this subject: Taxes For Our Own Good, concluding that I believe that the suggestions to tax foods for public health reasons are misguided at best and may be counter-productive at worst. Not only do such taxes not work, especially when they choose the wrong foods to tax, they can become expensive liabilities for the businesses forced to become tax collectors on the government's behalf adding accounting and red tape costs. As Danish businesses were quick to report:

Businesses call fat tax a failure on all fronts

Levy costs millions of kroner and has not resulted in consumers making healthier choices, say food producers. Finance minister Bjarne Corydon (Socialdemokraterne) is not opposed to trimming the fat tax, but the lost revenue will have to be made up

Denmark's surcharge on the fat content of foods has cost businesses 200 million kroner since it was implemented last October, according to Dansk Erhverv, a business advocacy group. The tax has been expensive,” chamber spokesperson Lotte Engbæk Larsen told Jyllands-Posten newspaper. “Businesses have had to absorb the costs of administration, set up new IT systems and explain it all to customers and suppliers.”

Larsen said that the red tape was the only thing to come from the levy, since it did not encourage customers to pick less fatty food.

“There have been absolutely no health benefits gained from this tax,” said Ole Linnet Juul, of DI Fødevarer, a food industry advocacy group.

Yes, I will say I told them so. Food taxes are not the way to improve public health. Hopefully the social engineers promoting these taxes in other parts of the world, including my own country, will heed the lessons of this failed Danish experiment.

Cheers, Alan, T2, Australia

Everything in Moderation - Except Laughter

Lisa's Story

One of the nice things about being on several forums is seeing the success stories. Ordinary people doing extraordinary things. Not Olympic athletes but people like you and I who decided that they were not going to become part of the abysmal diabetes statistics but that they would restart their lives for longer, healthier happier lives with less risk of diabetes complications. I have collected a limited selection and listed them on Other's Stories.

Today this story was posted on the ADA forum. Lisa graciously granted me permission to repeat it here.

Hi! My name is Lisa, I have type 2 diabetes and this is my story.

I am a working mother/wife with four grown children and one grandchild. I am not very athletic, and my most favorite activity is reading my Nook. (Just ask my darling hubby! Oh boy, is he ever sorry he gave me that thing!) Exercise is a challenge for me. I am not into marathons or trendy exercise programs, just old-fashioned walking and biking. I am active in my church and love to help out wherever I can. I love my five cats. Yes, five! I acquired them while working through my empty-nest phase.

My story begins like most of us: hearing that my fasting blood glucose (BG) reading put me over the “limit.” No prediabetes, do not pass go, go directly to full-on diabetes. No “get out of jail free” card for me.

This had been on my radar for quite some time. Oddly, it still took me by surprise. I am on medications for high triglycerides, cholesterol, blood pressure and allergies. My liver is slightly enlarged due to non-alcoholic fatty liver disease (NAFLD). I don’t take medicine for this or my diabetes, but I was advised to lose weight. Gee, that never occurred to me! Still, I sometimes joke that I am a walking pharmacy. The pharmacy knows me by sight. This can be a good thing, actually.

Six years ago, I managed to lose 40 pounds and kept it off two years by eating a very low-carb, high-protein diet and lots and lots of walking and biking. Then a series of unfortunate life events sort of took the stuffing out of me, and much of that weight crept back on. I might have forestalled my diagnosis a few years with all that. Little did I know that the low-carb/high-protein diet was perfect for a person with diabetes!

Since my diagnosis in December 2011, with an A1C of 6.4 and fasting blood glucose of 146, my doctor agreed I should try to manage with diet and exercise. I went home, cried, ranted and then threw out all my junk foods. I went back on my diet program and got to walking again at least for 30 minutes as many days of the week as I could manage. I lost 20 pounds in three months. I’m kind of stuck there now. But, the A1C went down from 6.4 to 5.9 three months later, and then 5.8 after the next three months. So that’s good progress.

The hardest thing to deal with is feeling ashamed for allowing this to happen. I can sometimes feel alienated from others and resentful of my situation when I have to say “no" to certain food—foods that I am, on the inside, drooling to devour! Also painful is that the media tends to focus on the questionable idea that diabetes is caused by being overweight . . . like it was my fault.

Within the American Diabetes Association’s online community, I have found hope and the knowledge that this was not my fault. I have realized that I can manage my diabetes and still live a full, happy life. I found necessary information on what BG levels I should be looking for in fasting, pre-meal and post-meal glucose monitoring. Test, adjust, retest (as my fellow members Alan_S and LizzyLou recommend). Most importantly, I found motivation due to the dreadful complications that can happen to me if I do not keep my glucose levels down.

The most morale-boosting, uplifting thing is chatting with people who understand what it is like to ride the roller coaster of high glucose, then go low, then feel cranky, sleepy, dizzy and just all-around crazy. Who knew food particles on our fingers could affect meter readings? Who else would understand our frustrations? Who else could we ask, “Why are my feet tingling? I only had one baby-size ice cream cone! You mean all that tingling and jack-hammer pains in my toes are from high glucose?” These people "get it" in ways I pray my dear family and friends never will.

So, I will endeavor to remain in the “5% club” without medications as long as I can. I have no problem taking them, if it becomes necessary, if it means keeping complications at bay. I will exercise, eat according to my meter and keep up with my new friends on this community. They offer so much inspiration, motivation and humor in our situation so I can laugh, learn and improve instead of cry, backslide and give up.

Never give up!

Take Care,

Lisa

Thanks Lisa.

Cheers, Alan

Everything in Moderation - Except Laughter