how many a month?

[Klocky]

"Avoiding being overweight, exercising and eating a healthy diet in general is far more important than fretting over whether a bowl of cornflakes sends you 0.5 higher than a slice of toast"

Admittedly I am overweight - I have lost 2 stones and now another 2 to go since being diagnosed in September - however, without the testing, going with the advice of the nurse at my GP practice, I would very likely have carried on eating the wholemeal bread advised - I wish this did send me 0.5 higher - unfortunately bread - any type of bread, even Burgen - gave me readings of above 15 every time 2 hours after eating and without testing, there is no way I would have known this. I do use the strips very sparingly, I do have to pay for them since none of my GP's will prescribe even after me showing them my food diary and all I was doing to try to help myself - they blamed the PCT and said only T1 are allowed strips on prescription.

Sorry, I'm ranting a bit now but I really do feel it is essential for newly diagnosed Type 2s to test.

 

[fruitloaf]

We have had similar threads to this previously. The first thing is you need to separate insulin users from non-insulin users as it is a completely different usage.

I usually only test a couple of times a week if I remember. Really just to monitor that my pre-food level isn't creeping upwards and odd times after a meal just to see how high it goes. Although I wasted a good few strips on the breakfast thread which on told me that bacon and eggs causes my BG to rise less than Shredded Wheat which I already thought would be the case.

Most doctors and DSNs do not believe frequent testing by non-insulin (or non-sulphonurea) type 2s is of any medical value. It isn't because the whole of the NHS is out to get you.

Avoiding being overweight, exercising and eating a healthy diet in general is far more important than fretting over whether a bowl of cornflakes sends you 0.5 higher than a slice of toast. In my experience many type 2 testing 'junkies' are often very much overweight and their real problem is staring them in the face. But it is easier just to watch their numbers up an down and fret over their food and get themselves into right old panics over imagined hypers/hypos.

If these sort of cases think they really must test frequently (and we are talking about several times a day not whether they should test at all) it is their choice. The question is really should the NHS pay for it? I personally have never been refused any test strips but I use them sensibly (except for the the odd bacon and egg vs Shredded Wheat test 😉 )

Rob

I agree, very well explained.

There are so many variables involved, there is little use in doing lots of tests and then expecting to be able to get useful information from it that you can act on. For example a type 2 patient eats a pizza and tests 1 hour afterwards. The result is 11.9:
is that too high? what should I do about it?
does it mean I can't eat pizza again?
can I eat a different type of pizza?
or a different size of pizza?
or a pizza with a different topping?
was it the pizza or was it something else I've eaten?
is the glucose peak at 1 hour or should I have tested at 1.5hrs or 2 hrs instead/aswell?
is my metformin dose too low?

....you can't expect people to go through that after every meal!

far easier for a patient to understand is to give general lifestyle advice, refer to dietician, explain effects of different foods on glucose control, encourage people to look at food labels etc. Monitor HbA1c to assess glycaemic control.

doing lots of glucose tests after eating different foods might be interesting but I don't believe it actually has a big impact on overall glucose control.

 

[Andy HB]

I agree, very well explained.

There are so many variables involved, there is little use in doing lots of tests and then expecting to be able to get useful information from it that you can act on. For example a type 2 patient eats a pizza and tests 1 hour afterwards. The result is 11.9:
is that too high? what should I do about it?
does it mean I can't eat pizza again?
can I eat a different type of pizza?
or a different size of pizza?
or a pizza with a different topping?
was it the pizza or was it something else I've eaten?
is the glucose peak at 1 hour or should I have tested at 1.5hrs or 2 hrs instead/aswell?
is my metformin dose too low?

....you can't expect people to go through that after every meal!

far easier for a patient to understand is to give general lifestyle advice, refer to dietician, explain effects of different foods on glucose control, encourage people to look at food labels etc. Monitor HbA1c to assess glycaemic control.

doing lots of glucose tests after eating different foods might be interesting but I don't believe it actually has a big impact on overall glucose control.

Your point is fine. But it's easier not to overcomplicate things. Rather than going through all the possible permutations, the type 2 would simply conclude that pizza should be generally avoided.

But I fundamentally disagree with your last paragraph for newly diagnosed diabetics who don't yet have a good understanding of their condition. Understanding that certain foods should be avoided will, of course, help overall glucose control. It certainly helped me in my early days.

Andy 🙂

 

[SweetGuy]

"Avoiding being overweight, exercising and eating a healthy diet in general is far more important than fretting over whether a bowl of cornflakes sends you 0.5 higher than a slice of toast"

Admittedly I am overweight - I have lost 2 stones and now another 2 to go since being diagnosed in September - however, without the testing, going with the advice of the nurse at my GP practice, I would very likely have carried on eating the wholemeal bread advised - I wish this did send me 0.5 higher - unfortunately bread - any type of bread, even Burgen - gave me readings of above 15 every time 2 hours after eating and without testing, there is no way I would have known this. I do use the strips very sparingly, I do have to pay for them since none of my GP's will prescribe even after me showing them my food diary and all I was doing to try to help myself - they blamed the PCT and said only T1 are allowed strips on prescription.

Sorry, I'm ranting a bit now but I really do feel it is essential for newly diagnosed Type 2s to test.

Well done losing the weight Karen. I think that losing 2 stone will be more beneficial to your condition than any amount of testing.

I agree that newly diagnosed type 2s should test to familiarise themselves with their condition. And it is encouraging when you can see meds or diet and exercise regimes actually working.

But some type 2s do go on testing forever multiple times daily as though they were type 1s. And I do feel this is usually a waste of time and money, and it really doesn't really help them in any way.

 

[Northerner]

...doing lots of glucose tests after eating different foods might be interesting but I don't believe it actually has a big impact on overall glucose control.

I'd beg to disagree with that Rob. People can be very individual in what they can tolerate but are often given either 'standard' one size fits all advice or conflicting advice, so in the early stages it is essential to try and build up a picture of how food affects you generally - do you react badly to porridge, or baked potatoes, or certain types of bread (even things that are supposed to be 'ideal' for everyone)? A lot of this will build up a good general picture of what is OK, what is OK occasionally as a treat, and what needs to be avoided. Even a really good dietician can't know all this, and a 3 or 6 monthly HbA1c doesn't give you any information of where you might have gone wrong. I don't see how a dietician could possibly suggest any changes after 6 months with no other data if HbA1c had risen. The more likely outcome would be that medication would be increased, at extra cost to the NHS and to the patient's quality of life.

I agree that once this general knowledge is built up then testing for T2s can be occasional, as Sweetguy says, just to make sure you are 'on track'.

As I said before, testing is only useful if you can use the information. In your pizza example then the lesson would be - don't eat pizza if that represented a big spike, except maybe occasionally as a treat.

 

[fruitloaf]

but the point is that if that is the message you want to give to people why not just tell them rather than expect them to do all the hard work testing etc. As a way of educating people it might be useful to do some tests pre and post meals but all diabetics will find that eating a high carb meal increases their glucose, it shoudn't come as a surprise (This is much easier to explain than the effect of insulin resistance which in the long term may be improved by weight loss.) Some may decide to reduce their carbohydrate intake either slightly or dramatically, whereas some may decide not to. Again this area is controversial so HCP might give conflicting information. Some may decide to concentrate on weight loss. Being diagnosed with diabetes is quite a lot of information to take in as it is but if you can't give someone clear rules as to how to interpret their glucose result (as you can with someone who is on insulin/ at risk of hypos) then what are they expected to do with that information.

 

[macast]

far easier for a patient to understand is to give general lifestyle advice, refer to dietician, explain effects of different foods on glucose control, encourage people to look at food labels etc. Monitor HbA1c to assess glycaemic control.

doing lots of glucose tests after eating different foods might be interesting but I don't believe it actually has a big impact on overall glucose control.

I really don't agree with you Fruitloaf... sorry 😱

if I had gone by what my DSN had told me (and the other dietary advice the healthcare team supplied) ie eat plenty of carbohydrates but don't eat white bread or white rice... change them for brown. I wouldn't ever be able to improve my HbA1c EVER. by testing I have learned that starchy carbohydrates send my levels way up high and they don't come down until it is time for the next meal. just tell me how that is useful and how that is going to show the next time I have a HbA1c test???

I have always looked at food labels and have always been careful with my diet.... and indeed I thought I had a very healthy diet.... for a 'normal' person. but for a person with diabetes I had a dreadful diet.. with far too many starchy carbs for ME. before diagnosis I ate organic good quality bread with grains and seeds.... I ate porridge for my breakfast with a good portion of berries..... I ate at least 5 pieces of fruit per day and several portions of veg. I included rice, pasta or potatoes in a meal that didn't include bread (or porridge)... I ate several portions of oily fish. I rarely ate processed food. now that is a good healthy diet.... and I would have continued with that diet thinking it was good if I hadn't got myself a meter and started testing

what is ok for one person is not necessarily ok for another person. we are all different. and different foods do different things to our BG levels. so how is a dietician going to know that my levels rocket with a slice of organic seeded bread???

anyway.... I am one of those people who have to take charge of my own health.... tell me what is wrong with me.... then I will deal with it and find the right way to go ... for me!!

I know I am new to this diabetes..... but I have learned an enormous amount by testing myself before and after different foods and exercise... and now I can act on that and use that information when chosing what to eat 🙂

 

[macast]

but the point is that if that is the message you want to give to people why not just tell them rather than expect them to do all the hard work testing etc.
..................
......
Being diagnosed with diabetes is quite a lot of information to take in as it is but if you can't give someone clear rules as to how to interpret their glucose result (as you can with someone who is on insulin/ at risk of hypos) then what are they expected to do with that information.

gosh Fruitloaf..... we have diabetes ... we are not stupid. some of us like to take charge .... when the meter shows a high reading that means that the food should be a) avoided altogether b) cut down the portion size or c) only eaten very rarely if necessary

 

[Northerner]

...anyway.... I am one of those people who have to take charge of my own health.... tell me what is wrong with me.... then I will deal with it and find the right way to go ... for me!!

I think this is a very important part too. Some people feel much more in control when they understand what is happening (I am one of those people!), whereas there are a lot of people who would much rather not have to think about it but just be told how best to manage things (my 70yo neighbour is like this). Part of quality of life with diabetes is how you relate to it. For those who would rather just get on with what they are told and prescribed, then their QOL is probably improved by removal of responsibility, but for those who would be wondering all the time if they are doing things right, with only vaguely explainable results might be constantly worrying. It's a case of finding a happy medium for each individual, which does take time and effort on either the individual's or the HCP's part.

The situation that needs to be avoided is where a person tests and is constantly worried about the results they see so it becomes an obsession with no purpose other than than to impair quality of life.

 

[macast]

The situation that needs to be avoided is where a person tests and is constantly worried about the results they see so it becomes an obsession with no purpose other than than to impair quality of life.

I agree with you Northerner..... testing for testings sake is pointless (excuse the pun 🙄)

but for people like us who want to know what is happening to the body then testing and acting on it is the only way

I would have worried myself into an early grave if I'd been made to wait 3 months for another HbA1c test result before knowing if I'd made any improvement

but with regular testing of the different foods I can take charge of my own improvement as I know I am doing everything I can to make changes

ps.... I'd just like to add that my way might not be suitable for others...... this is MY way.... not the ONLY way 🙂

 

[fruitloaf]

I really don't agree with you Fruitloaf... sorry 😱

if I had gone by what my DSN had told me (and the other dietary advice the healthcare team supplied) ie eat plenty of carbohydrates but don't eat white bread or white rice... change them for brown. I wouldn't ever be able to improve my HbA1c EVER. by testing I have learned that starchy carbohydrates send my levels way up high and they don't come down until it is time for the next meal. just tell me how that is useful and how that is going to show the next time I have a HbA1c test???

I have always looked at food labels and have always been careful with my diet.... and indeed I thought I had a very healthy diet.... for a 'normal' person. but for a person with diabetes I had a dreadful diet.. with far too many starchy carbs for ME. before diagnosis I ate organic good quality bread with grains and seeds.... I ate porridge for my breakfast with a good portion of berries..... I ate at least 5 pieces of fruit per day and several portions of veg. I included rice, pasta or potatoes in a meal that didn't include bread (or porridge)... I ate several portions of oily fish. I rarely ate processed food. now that is a good healthy diet.... and I would have continued with that diet thinking it was good if I hadn't got myself a meter and started testing

what is ok for one person is not necessarily ok for another person. we are all different. and different foods do different things to our BG levels. so how is a dietician going to know that my levels rocket with a slice of organic seeded bread???

anyway.... I am one of those people who have to take charge of my own health.... tell me what is wrong with me.... then I will deal with it and find the right way to go ... for me!!

I know I am new to this diabetes..... but I have learned an enormous amount by testing myself before and after different foods and exercise... and now I can act on that and use that information when chosing what to eat 🙂

Again it's not really new information. Starchy carbohydrates increase your blood glucose, they do for everyone. The reason your DSN told you to eat these rather than white bread etc is that is the general advice that is given by NHS professionals at the moment. Many people on here will rave about the benefits of low carb diets etc and while I'm not going to start that debate again here, yes if you eat an omlette rather than 3 slices of toast then you will not get a glucose spike.
If your DSN had told you to eat a low carb diet would you still feel the same way?
Maybe dietary advice given to diabetics should change? I think it is changing slowly in some places. I am slightly biased in that I work in a clinical laboratory so feel there is no point in doing blood tests if it won't give you new information that you can act on.
What frustrates me is that there are so many comments from new diabetics on here saying that different HCP tell them to test/tell them not to test/don't give them clear instructions about when to test or how often or how to interpret the results. I still think it is better to give them the right information to start with i.e. a diet high in starchy carbs will cause high glucose levels, weight loss may improve your glucose control in the long term and let people decide whether to change their diet or not.

 

[AlisonM]

While I was still thought of as a Type 2 I was told to do the low-carb thing and it did seem to help, at least for a while. I still keep to it now though not perhaps as rigidly as I did at the beginning. I was also advised to test before and 1, 2 and 3 hours after eating to see what effect various foods would have on me so I could learn what to avoid - "it's different for everyone" I was told.

As an example, if you look at the breakfast debates, you can see how different foods affect folk differently. There are notable differences even among folk who have the same type of diabetes. How can folk know that without testing? There's no set pattern for any of us and only by testing can an individual find out what works for them.

One other point, you must realise not all T2s are referred to DSNs or Diabetic clinics, and many are left to struggle with the thing by themselves as their surgeries don't pass on information in any coherent way. Also, what information they do get can often be out of date. There's no standard methodology for dealing with Diabetics it's all left to the PCT to decide what they will do and many are falling far short of the ideal. The NICE guidelines are often ignored and are too vague and contradictory any way.

 

[Steff]

A monthly amount for me is 100, mine are on repeat prescription but they has been once when i was questioned on how many i was using as they seem to think i was back abit too quick asking for more......

 

[Klocky]

Originally posted by Fruitloaf

"so feel there is no point in doing blood tests if it won't give you new information that you can act on"

But the testing IS giving me new information that I AM acting on.

 

[xxlou_lxx]

Your point is fine. But it's easier not to overcomplicate things. Rather than going through all the possible permutations, the type 2 would simply conclude that pizza should be generally avoided.

But I fundamentally disagree with your last paragraph for newly diagnosed diabetics who don't yet have a good understanding of their condition. Understanding that certain foods should be avoided will, of course, help overall glucose control. It certainly helped me in my early days.

Andy 🙂

I reckon if i was type 2 id have a massive food phobia! avoid everything I really do have huge respect for type 2s because unlike me being type 1 I just inject insulin if i fancy something and its not that easy for you guys 🙄

 

[fruitloaf]

Originally posted by Fruitloaf

"so feel there is no point in doing blood tests if it won't give you new information that you can act on"

But the testing IS giving me new information that I AM acting on.

but my view is that you weren't given the correct information to start with. Some people may argue that everyone reacts differently to different foods but actually generally speaking all diabetics will react in a similar way to particular foods. As a type 1 diabetic I don't eat something test my glucose 2 hours later to work out how much insulin is needed. I don't need to I just look on food labels to work out the carbohydrate content.
Instead of saying to a type 2 diabetic - test after eating different foods and don't eat foods that cause a glucose spike - you might aswell say 'go on the atkins diet' because it amounts to the same thing. I'm certainly not advocating the extreme low carb diet, but that is the conclusion you would come to.
There have been several studies published looking at the effect of home glucose monitoring in type 2 diabetics (not on insulin or at risk of hypos) and all that I have seen have shown that it doesn't have an effect on long term glucose control and hence development of complications. It also has been shown to cause a reduction in quality of life.
it costs the NHS 100million a year. If it was a drug then no PCT would prescribe it because the evidence does not indicate a clear benefit.
If I was a type 2 diabetic I'm sure I would want to test my glucose and it would be interesting to test at various times after eating etc but I don't think the NHS should fund this.

 

[Klocky]

Suspect we'll ever reach agreement me old fruit, so I'll leave it there 😉

 

[macast]

.
If I was a type 2 diabetic I'm sure I would want to test my glucose and it would be interesting to test at various times after eating etc but I don't think the NHS should fund this.

I don't consider my testing to be 'a bit of fun' .... I do it because I want to know what is happening when I eat.... so that I can make sure I eat sensibly and according to my body's requirements. I want to get this D under some sort of control.... I'd rather not have to take meds or go on insulin if I can avoid it.... and surely my testing strips are cheaper than meds and insulin so will save the NHS in the long run

I really don't expect the NHS to fund my 'bit of fun'.... I have had 100 strips from the NHS and have bought 100 strips myself. I don't expect to be continually testing for the rest of my life.... just for the first few months til I get to grips with it all and learn about the different foods

and of course I'm hoping to learn more about diabetes in general when I go on my Desmond course later this month 🙂

 

[Northerner]

I think the argument is becoming rather circular now, so I'll close the thread.