Is At Home Glucometer Monitoring Truly Effective? New Research Says Maybe Not!
Do you use your glucometer as much as you should at home? Now, I am talking to type 2 diabetics for the most part, not insulin dependent type 1. I often think while at work, “why
are we checking patient’s blood sugars 4 times a day if we aren’t covering them with insulin”? Being on a cardiac floor, most of our patients get tight insulin control, but there is the 30% that we seem to be sticking just to stick.
I also know that I check my own sugar 3 times a day, but if I am flying high in the 300’s, I can’t correct the issue due to not being on injectable insulin at the present. So why even do it? I am compliant though and continue to keep a journal, but I know that there are many type 2’s out there that say, “why check if I am not treating the problem, so why waste money and time”?
And that would be just what a new study examined… The effectiveness of at home glucometer monitoring by type 2 diabetics.
The study, published in the online edition of the British Medical Journal, found no conclusive evidence that home monitoring improved glucose control, Health Day said Wednesday.
They also found that most patients in the study did not even continue their monitoring to the end of the research. And then there is that whole insurance dilemma. Some insurance companies cover diabetic supplies and some do not, and take it from someone that has a private health insurance company that does not, it is expensive. I can see how that would be a deterrent for a lot of diabetics.
So what do you think? Do you think patients are compliant at home with their glucometers or do you think we should concentrated on more effective options? Hmm… tough one, I have mixed emotions on this one personally. Tell me what you think though? Come on, I know that someone is out there with an opinion.
Tags: 300, 4_times_a_day, blood_sugars, british_medical_journal, conclusive_evidence, control_health, day_said, dependent_type, diabetics, glucometer, glucose_control, home_monitoring, injectable, insulin_control, private_health_insurance, waste_money
16 opinions for Is At Home Glucometer Monitoring Truly Effective? New Research Says Maybe Not!
RevJustin
Jun 28, 2007 at 3:31 pm
Testing for a diabetic can be a lot like stepping on a scale is for people who worry about their weight. Seeing those high numbers and then feeling like you have no control over them can be de-moralizing and lead to depression (temporary or otherwise) that then makes actually taking control more difficult. Basically, it is negative feedback and for some, no matter how rational, this has a visceral impact.
For those who can’t take insulin to correct a high, this can happen a lot. Once people get a sense of how food/exersize, etc impacts their blood sugars , testing is really only a way to see if things are getting better or worse and since that is a long-term assesment anyway, frequent testing is a hassle, expense, negative reinforcer that may do more harm than good.
Kendra James, RN
Jun 28, 2007 at 7:24 pm
Well put. I agree with so much of what you said. It is a tough call. Do you want to see that number that you can’t do anything about or do you want to live not knowing? Different strokes for different folks!
Dr. Dino
Jun 29, 2007 at 5:26 am
It is probably useless to measure glucose frequently unless the practitioner provides some context. An example would be:
“Why don’t you start measuring your sugar frequently at different times a day so you can see how your sugar reacts to different foods. You may learn something about foods you didn’t know you were supposed to avoid, or just how your sugar reacts when you cheat and especially when you exercise. Bring in your diary and we’ll look at it together. Once you get the hang of it, you won’t need to check your sugar as often.”
For the docs: Stick that in your P4P bonnet! If your productivity doesn’t tank.
debbi
Jul 2, 2007 at 6:49 am
Diet and exercise controlled, test once daily, alternating between fasting and before dinner. I would prefer to test more often, such as before and 2 hours after a meal. This would give me more info on how specific foods impact my BG’s, and if high, I can go for a walk to bring it down. If told to discontinue testing, I fear slipping back into bad eating habits. My overall control is great (A1C=5.1) but I need that daily BG number as motivation to continue the struggle to control my diabetes.
Stuart
Jul 5, 2007 at 12:00 pm
Using the glucose monitor several times per day has enabled me to determine how many foods affect my blood glucose and the effects of exercise. It also helps me understand why I might be feeling hyper, sluggish or grumpy. My resulting control is excellent A1C = 5.7! My meter is a wonderful tool for my diabetes management. I would feel helpless without it. I will continue to use my meter on a regular basis regardless of what some silly study might say.
Roger Holmen
Jul 29, 2007 at 8:25 am
To be truly successful, managing diabetes is up to the patient. To do that, they must know what their blood glucose is at various times in relation to varioius everyday lifestyle choices they make regarding food, exercise & medications.
My Dr wants me to test once a day at random times. What does that tell me? Did I learn something that would help me improve my bg’s (& HbA1c)? Not on your life.
This, IMHO is absolute nonsense & part of the reason so many diabetics end up in the hospital with one or more of the many possible complications.
Some who’ve responded to this thread seem to think that when they get bad readings that there is nothing they can do about correcting the situation.
Not so.
Diabetes is a disease that can be controlled with some combination of diet, exercise & medications. It is, in fact, one of the few diseases that we, the patient can & must take an active part in the treatment if it is to be successfully controlled.
And it can be safely controlled to a level to minimize the risk for all the horrendous complications that can befall those who don’t have good control.
But to achieve a good level of control, testing frequently is a must. It is perhaps the most valuable part of a diabetic’s education about the disease & how to control it.
When I talk about good control, I’m talking about keeping bg’s in the range of a normal non-diabetic (fasting/pre-prandial 70-110mg/dl & HbA1c 4.5% to 6%. It can be done, but it does take work.
I am a Type 2 for 9+ years now, with a HbA1c ranging from 5.2% to 6.0% & no indications of any complications. This was accomplished by controlling my intake of carbs & knowing how what I ate effected my bg’s. I tested as much as 11 times a day. Three times around meals, fasting & bedtime.
My basic position is that without sufficient testing, a diabetic is flying blindfolded as they really have no idea what is happening to their bg’s. Once a day, once a week or “never” testing is a recipe for disaster in the long-run.
Roger
Kendra James, RN
Jul 29, 2007 at 9:11 am
I do think that monitoring is essential in controlling your blood sugar. It is frustrating though when you see that high number and have stuck to your diet and can’t have an immediate fix. But it does give you info to help fix the issue! I appreciate all the comments.
Roger- agreed!!! and congrats on great numbers
Stuart and Debi- thanks, and I have to say I agree with y’all also, and your numbers are great too, because you keep tabs, that is great!
Dr Dino- Absolutely!
Thanks for your words and time, comments are great feedback! :)
Fred Bonjour
Jul 29, 2007 at 10:16 am
These diabetics were likely told to check their BS several times a day and not taught what to do with the readings. If what you measure has no impact on what you do, why do it?
Diabetics, especially new diabetics, need to be taught how to “eat to the meter” to control their BS. This means, that within reason, there are no “diet” restrictions. The only limit from a diabetic point of view is what are your after meal, post prandial, BS readings. If they are high you have to react to it. Kid of “if it hurts, don’t do it. Modify the meal that caused the offending BS to bring it down, downsize the portion or cut carbs. Carbs are OK, even white ones, if they don’t impact your BS, but I suspect that your meter will say they do.
My Dr. actually told me on diagnoses that I didn’t need to test at all. How was I to see what I needed to change? Prior to diagnosis I suspect that the vast majority of us did not eat right. We respond very poorly to the word “diet”. Saying you can eat anything (yes I did say anything) BUT, (the big BUT) you have to check your BS prior to a meal to see the starting point and after a meal to see what impact that meal had, and you MUST change something to reduce the impack of a meal that results in high BS. Obviously the result is not instant, but the resulting improvement in lifestyle when you retain your sight and limbs is immeasurable.
Kendra James, RN
Jul 29, 2007 at 12:04 pm
Hey Fred,
Thanks, I think it is great to have all these differing techniques and points of view. Your thoughts are appreciated! Have a good day! :)
Roger Holmen
Jul 30, 2007 at 5:38 am
I strongly agree with Fred’s “eat to your meter” mantra.
Over my years since my diagnosis I’ve attended several different “diabetes education” classes put on by CDE’s & RN’s plus numerous “in person” diabetes support groups & I’ve never heard this concept mentioned. When I’ve brought it up, it’s like I’m talking in a foreign language.
But it’s a frequent suggestion on a couple of online diabetes support groups that I participate in which are populated by a lot of DMers safely & successfully controlling at or near “normal non-diabetic” levels to minimize complications.
Kendra,
Do CDE’s teach such a concept?
Without taking action based on test results, I’d agree with the “why bother testing” arguement!
I strongly feel that diabetics need to be taught that to really control this disease, it’s largely up to them to be “pro-active”, do the testing & take appropriate actions based on that testing.
Not doing so & following the current practices is what’s led our hospitals to be literally filled with folks with one or more diabetic complications.
No, most patients don’t want to do anything about their disease, expecting the Dr to prescribe them some easy cure that requires no action on their part.
They need to understand that if they don’t work to control their diabetes to at or near “normal non-diabetic” bg’s, that in most cases, there will, in time, be complications & quality of life will suffer greatly.
Drs can only prescribe treatments like medications or insulin, but it’s up to the patients to make the daily choices that can really control diabetes, primarily regarding diet.
As a society, we’ve come to expect our doctors to “cure us”, with no more actions on our parts than taking a pill (or insulin). With diabetes, for best long-term prognosis, it just doesn’t work that way.
It’s really sad when I talk to diabetics with complications & they say “I did what my Dr/Nurse/CDE told me to do so why did this happen”?
Well, IMHO it’s because they weren’t told enough & made to understand that with diabetes they must be the one that controls their disease.
This is not emphasized enough.
Roger
Vicki
Jul 30, 2007 at 7:28 am
I must add my 2 cents here. Many docs are still telling diabetics that an A1C of 7 is “excellent”. It most definitely is NOT excellent. With an A1C of 7 the diabetic can eventually expect diabetic complications - painful peripheral neuropathy, poor wound healing and need for amputations, heart disease, blindness, kidney failure and need for dialysis in order to remain alive. With an A1C of 6.5 or under - the more under the better - all these disaster scenarios can be avoided.
And what should our BG goals be? No higher than 140 at 1 hour after eating, 120 2 hours after eating. And yes, these goals are reachable with some effort. It will likely mean giving up some of your favorite foods. But weighing that against the loss of properly functioning body parts makes it worth while, at least to me.
And what foods are the major culprits? High glycemic index foods, such as ANYTHING made with grains - and this includes cereals, pastas, breads; starchy veggies such as potatoes, and rice, as well as most fruits. A small amount of berries can be eaten, as they are the lowest GI fruits.
The best advice diabetics should be given is, as others have said - EAT TO YOUR METER. Test before your meal as well as 1 and 2 hours afterwards. If your BGs go above 140 at 1 hour and 120 at 2 hours, try deleting those high GI foods from your diet and test after that meal at the times mentioned. You may be be surprised at the results.
I understand that some diabetics may not want to make the effort. But doctors and CDEs owe it to their diabetic patients to at least let them know that eliminating those foods from their diet will vastly improve their chances of avoiding diabetes-related complications.
Kendra James, RN
Jul 30, 2007 at 7:42 am
Thanks again Roger and Vicki. Just remember I am bringing you research and studies, I don’t always agree with them, but it is food for thought, which is what some diabetics need to see the bigger picture. I personally, except for me forgetting my glucometer on vacation, test 3 times a day and if it is high, then I don’t eat that combo again, if it is low, I know I am ok. I agree with low carb options but, as the ADA says, I don’t think you should cut them out entirely UNLESS you can not handle them with your readings. And fruits, I think you need them and there are plenty that are lower than 60 on the GI. Which is except able IF IT WORKS FOR YOU. That is the bottom line, use your meter to determine what works and unfortunately the larger population of hospital patients don’t use it, hence why they are there in SOME cases. Maybe since I had so many comments I will open up a new discussion about this later in the day with a new post and some new research techniques. Thanks for all your thoughts, opinions, and time, this is what makes writing worth it!
I Will Tell You Mine, If You Will Tell Me Yours…
Jul 30, 2007 at 12:13 pm
[…] mic” night kind of thing. I thank all of you that commented on my previous post “Is at home glucometer monitoring truly effective? New research says maybe not!“. There was some differing points of view, which is always nice. Yes, we all have diabetes […]
Roger Holmen
Jul 31, 2007 at 6:05 am
Kendra,
Thanks for posting the studies.
What bothers me though about a study that says that self-testing is not really useful is that it will encourage even more diabetics to not test because that’s what some “study” said was OK!
I’d bet that this study was done on a sample of diabetics that are typical in that they were told nothing about what to do with the test results. So, of course the testing is of no benefit.
The best I can tell, that’s the vast majority of diabetics.
Drs, Nurses & “diabetic classes” do not tell their patients what to do with the information & I don’t understand “why”. I’m willing to bet that even those same Drs & Nurses don’t know what to do with the testing information, so how can they possibly pass knowledge on to their patients?
Shouldn’t this be something learned in medical school? If it is taught, it’s soon forgotten.
I can understand why a Dr might not have the time to instruct their diabetic patient on testing & what actions to take based on the results. They are very busy. But I’d think that it should definitely be part of a DE class, but is not in the several I’ve attended.
From what you say, it sounds like you may be teaching this information in your classes & that’s a good thing. The CDE’s I’ve listened to in person don’t even come close to mentioning the subject.
Now, on the ADA—
Many, if not most, in the medical community give their patients a diet plan based on the ADA’s recommendations. This will usually include upwards of 150 grams of carbohydrates per day.
For Type 2 diabetics, there is one food type that makes their bg go up & that is carbs.
Each gram of carbs can raise our bg’s by 3 to 5mg/dl, so pencil that out against that 150+ grams of carbs per day.
Does it make any logical sense to prescribe high amounts of the very food that will aggrevate our bg situation?
As I see it, the ADA’s treatment regimen for diabetics is “here, eat lots of carbs to drive your bg’s up & now take these medications to bring them back down”. They don’t say it in those words, but that is what is the result.
To get back on original topic—If people would really test before & after eating, “eating to their meter”, they would see that what they were most likely told to eat just isn’t working for them.
Without testing, they are lost.
Administrator
Jul 31, 2007 at 6:25 am
Roger- Awesome info. And you are so right eat to YOUR meter! Thanks again, and email me if you ever want to try your hand at a guest post, or write about a new topic that I haven’t touched on. Everyone is welcome to do that, fresh content and writers are always a nicety. :)
Roger Holmen
Aug 1, 2007 at 5:27 am
I don’t see your e-mail address anywhere on the blog so I’ll answer here. Not sure if you are the one who gets mail under the “contact us” button.
If there’s some e-mail address you’d like me to use to communicate with you “off-blog”, just e-mail me directly if you don’t want to publish it to the world.
You must have my e-mail address from my sign-in registration?
I would be happy to write on any “diabetes” topic , where I have personal experience or have done my own sort of research of the topic.
Much of what I know is personal experience plus communications with a lot of other diabetics that are also striving to control their bg to a level to minimize complication risk.
I feel that many, if not most diabetics are not given sufficient knowledge about this disease, what can be done & what results can be achieved thru “their efforts”. As I probably said before, diabetes is unlike most other diseases in that it’s the patient that must make most of the daily decisions that will determine the ultimate outcome.
It isn’t necessarily easy, at least at first, but it can be done. It’s not rocket science & being done on a regular basis by even “little old ladies”. Don’t mean that to be an offensive comment, but just to say “it can be done by anyone who’se motivated to try”.
Anyway, contact me if you’re still interested in my contributions.
Roger
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