Finger prick tests, are they a waste of time?

[saz9961]

I test myself daily. I can't more than twice a day, except on the odd occasion when I'm trying some new food. I was diagnosed in October 2024, and my approach has been to rapidly shed the weight, then adjust diet to a "normal diet", but not going back to the winegums etc. So started on <1000kCal a day for 8 weeks, now, I suppose, 2000kCal, but I'm not counting.

I measure last thing at night, and first thing in the morning. I don't know if this is the right times to do it, if you are going to pick 2 times a day. I track my readings as a 30-day and 60-day rolling average (and soon 90-day rolling average) in the hope that this will give me some sort of trend analysis what my next HBA1c is, whenever the NHS graces me with a test. I started with a HbA1c of 88, so way up there, like many I suppose.



To my mind, that looks pretty good. I lost 10kg in the first 6 weeks, and a further 5kg since, down to 91kg. I do feel better for it. The whole meal plan diet went away after the first 8 weeks. A little drift up naturally during the Xmas break, to be expected.

The finger prick test only seems useful for highlighting food that has a catastrophic effect on me, I know pasta has a sustained impact n me, so does Burgerking buns and wholemeal bread. New potatoes, jasmine rice, doesn't even budge. If I have a cold, I know the numbers go up a bit.

But actually, I generally have no idea what goes on during the day, nor the period between going to sleep and waking up, and how those short term spikes relate to HbA1c, if they do at all. This is obviously all related to remission; going from medicated up, on 4x metformin a day, to going cold turkey for 3 months, relying on 2 measures a day.

Am I measuring correctly?

 

[Martin.A]

The usual testing regime is on waking (fasting test), immediately before eating (pre-prandial) and 2 hours later (post-prandial). The fasting test will show how your body is managing your BG in the absence of food and exercise. I've generally tested within 5 minutes of getting up. The pre- and post-prandial tests show how our bodies cope with meals and is useful in sorting out our diets - reducing portion sizes or cutting things out altogether. I log all my results in a spreadsheet so that I can insert a trend line. I'm looking our for any signs of an upward trend that would suggest things might be going awry. I don't think about what's going on during the day or overnight. If I did I'd invest in a CGM.

Remission is possible, though not everyone manages it despite doing all the right things. No one knows why it works for some and not others. It's currently defined as 3 months with an HbA1c below 48 without taking any diabetes medication.

Well done on what you've achieved so far. Hopefully this will be reflected in an improved HbA1c when you're next tested.

 

[Leadinglights]

I'm not sure last thing at night actually tells you very much being probably too long after eating your dinner to see how well you tolerated that which would be a more useful thing to be tracking.
Yes first thing in the morning for tracking progress day to day, week to week etc.

 

[helli]

Are they worth it?
Depends what you are trying to achieve and what you do with the results you see.
As discussed (and you mention), testing before and after food gives you and idea of how your body tolerates that food.
But the morning (and night) reading is just a "tracker" for how well you are doing.
Your graph shows a steep fall at the start but your BG test results appear to have stabilised for now. Has it stabilsed at a level you are happy with or are you hoping for something lower? If you want something lower, are you doing anything to change that.

As you mention, this only gives you data for a single moment in time and gives little clue to what is happening between pricks and in relation to food so it is not a great indicator of HBA1c which is typically used to indicate remission.

If you are curious about what happens during the day, have you trialed the Libre? I believe they still offering a free 2 week trial if you have diabetes. So, if you have. a compatible smartphone you get a 2 week insight into those spikes and, if you think they are too high, you can make some further adjustments to your diet (or take a walk after eating).
My only caution is to be aware that all CGMs have limitations which you need to be aware of if you don't want to get frustrated.

 

[harbottle]

I test myself dail. I can't more than twice a day, except on the odd occasion when I'm trying some new food. I was diagnosed in October 2024, and my approach has been to rapidly shed the weight, then adjust diet to a "normal diet", but not going back to the winegums etc. So started on <1000kCal a day for 8 weeks, now, I suppose, 2000kCal, but I'm not counting.

I measure last thing at night, and first thing in the morning. I don't know if this is the right times to do it, if you are going to pick 2 times a day. I track my readings as a 30-day and 60-day rolling average (and soon 90-day rolling average) in the hope that this will give me some sort of trend analysis what my next HBA1c is, whenever the NHS graces me with a test. I started with a HbA1c of 88, so way up there, like many I suppose.

View attachment 34308

To my mind, that looks pretty good. I lost 10kg in the first 6 weeks, and a further 5kg since, down to 91kg. I do feel better for it. The whole meal plan diet went away after the first 8 weeks. A little drift up naturally during the Xmas break, to be expected.

The finger prick test only seems useful for highlighting food that has a catastrophic effect on me, I know pasta has a sustained impact n me, so does Burgerking buns and wholemeal bread. New potatoes, jasmine rice, doesn't even budge. If I have a cold, I know the numbers go up a bit.

But actually, I generally have no idea what goes on during the day, nor the period between going to sleep and waking up, and how those short term spikes relate to HbA1c, if they do at all. This is obviously all related to remission; going from medicated up, on 4x metformin a day, to going cold turkey for 3 months, relying on 2 measures a day.

Am I measuring correctly?

Both fasting and post-meal glucose contribute to hba1c.
It's possible to have a good fasting glucose, but high post-meal glucose which can elevate a hba1c.
Same the other way round.

How much fasting and post-meal levels contribute to hba1c can change based on how high the hba1c is, I believe.

 

[Fazza]

I did them when I was first diagnosed with T2 to see how my body reacted to the different things I was eating which is how I know I can have 3 plain digestive buscuits (but no more) and up to 10 seedless grapes without it having too much of an effect on my BG levels but haven't done them since.

A friend of mine (also T2) goes one further and has an app on his phone that is pretty much constantly checking his BG levels (something stuck on his arm) that he has funded himself and he is now obsessed with what his BG level currently is and if it's too high, there's nothing he can do about it so not sure what the use of it is for him other than messing up his mental health as he's obsessing with it.

 

[harbottle]

I did them when I was first diagnosed with T2 to see how my body reacted to the different things I was eating which is how I know I can have 3 plain digestive buscuits (but no more) and up to 10 seedless grapes without it having too much of an effect on my BG levels but haven't done them since.

A friend of mine (also T2) goes one further and has an app on his phone that is pretty much constantly checking his BG levels (something stuck on his arm) that he has funded himself and he is now obsessed with what his BG level currently is and if it's too high, there's nothing he can do about it so not sure what the use of it is for him other than messing up his mental health as he's obsessing with it.

The friend should use the data to adjust diet or medication.
Just using them for the sake of it is pointless and can cause anxiety. (For type 2s who aren't on medication like insulin)

 

[helli]

A friend of mine (also T2) goes one further and has an app on his phone that is pretty much constantly checking his BG levels (something stuck on his arm) that he has funded himself and he is now obsessed with what his BG level currently is and if it's too high, there's nothing he can do about it so not sure what the use of it is for him other than messing up his mental health as he's obsessing with it.

This is likely to be the Libre that I mentioned above.
It is invaluable for me with Type 1 because I can do something when my BG is too high (or too low).

The value is limited when you cannot react (although it can become obsessive) but when testing foods (or exercise or stressful situations) it can provide great data to help you learn what to do in the future based on more than two points in time (the spike may be earlier or later than 2 hours) such as avoid that food, do more exercise, do some meditation, ...
They can also be valuable to see what DOES work as well as the negatives.

 

[saz9961]

If not noticed, my plot shows rolling averages; the HbA1c is analogous to a 90 day rolling average (not 90 day average), but actually its closer to a 28 day rolling average, due to how RBCs are turned over.

A plot of daily measured is pointless



So, you see that high 8+ measure recently, that's what happens with a slice of wholemeal toast and marmalade. Never again.

My objective is whether my glucose is "controlled". My current 60 day rolling average is 5.64mmol/l, which apparently approximates to 31.7 on that HbA1c scale, but I know in practice that will be a gross underestimate. I have had zero help or interest from the NHS.

I will not deviate without medical advice. So if my objective is remission, what is the process to go from high dose metformin to no dose metformin, without creating risk. Cold turkey?

 

[Martin.A]

So if my objective is remission, what is the process to go from high dose metformin to no dose metformin, without creating risk. Cold turkey?

It's recommended that BG is brought down gradually. As is often said, it's a marathon and not a sprint. I did it by losing weight (87kg to 72kg), becoming much more active and adopting a low carb diet (less than 130g per day). It took me 5 months to get my HbA1c into normal range, by which time I was off medication after my DN said I probably didn't need it, and another 3 months to qualify as being in remission under the current definition.

 

[pjgtech]

I think you need to have a good reason to test, not just do it for the sake of doing it, IYSWIM?
When I started the T2D pathway to remission program, I was told to stop taking the metformin on day 1 of the initial 12 week very low cal diet, which I did. I had no side effects or cold turkey like symptoms.
But not everyone is the same, and I would not stop taking medication without suitable medical advice.
I test my BG about once a week in the morning when I get up, to give me a baseline fasting BG level.
If I'm trying a new meal, I test immediately before the meal, and then again approx 2 hrs after the meal, to see how my BG levels have reacted to the meal. You are looking for a rise of no more than 3, but ideally 2.
So if BG is 5 before eating, you want it to be no more than 8 or ideally 7 around 2hrs after the meal.
Also bear in mind your BG levels will naturally rise and fall ( a bit) every day anyway and depending on what you are doing, they do not remain static.

 

[everydayupsanddowns]

So if my objective is remission, what is the process to go from high dose metformin to no dose metformin, without creating risk. Cold turkey?

Different forum members seem to have received different suggestions from their GP / nurse about stopping Metformin.

It’s difficult to know quite how much it is currently helping your BG levels I suppose. In your shoes I suspect I’d be tempted to reduce in a stepwise fashion, much like the dose is generally increased over time - and monitor any changes to waking BG levels.

As for your current monitoring system, I think waking and last thing at night readings are likely to both be giving you ‘background’ information, which isn’t very actionable. Perhaps it would be helpful to stick with waking BG levels for the overall general level, and then use the other strips for more ad-hoc checks before and after meals to establish appropriate portion sizes and/or sources of carbs that don’t rapidly increase BG levels at 2hrs.

If you are fairly confident that your menu is fairly well optimised for you, then just occasional fasting checks to see whether levels are behaving consistently may be all that’s required for sort of ‘maintenance’ monitoring. You may decide you only need to check weekly (or even less frequently) to keep a weather-eye on things? Just enough info to help prevent slippage?

 

[snowball12]

I have changed GP practice and have a brilliant DN. She told me yesterday to only test once or twice a week!

 

[Leadinglights]

I have changed GP practice and have a brilliant DN. She told me yesterday to only test once or twice a week!

Whether that is good advice for YOU depends on why you test. It is your condition and up to you how you manage it.

 

[Proud to be erratic]

I have changed GP practice and have a brilliant DN. She told me yesterday to only test once or twice a week!

I think that advice can be very specific to an individual and the circumstances. Also without guidance on when that once or twice a week should occur is very important. Random testing at different times once or twice a week tells no-one anything remotely useful! Which makes this guidance inappropriate.

For someone who has longstanding diabetes, who is not insulin dependent and has achieved good BG management, then only testing infrequently could be good advice or still unnecessary. It really very much depends on both what a patient needs to know and might prefer to know (or not know). Some people simply don't want or can't deal with too much information and get stressed about the "obligation"; stress elevates BG, which is far from beneficial.

We each have different needs. For some structured, regular testing can be informative and reassuring. Thus potentially beneficial.

 

[harbottle]

I will not deviate without medical advice. So if my objective is remission, what is the process to go from high dose metformin to no dose metformin, without creating risk. Cold turkey?

I started on 1000mg of Metformin.
3 months later, I had a hba1c of 36 so it was halved.
It remained in the 36-38 region for a few years, and then they stopped it.
It didn't affect it.

But Metformin may not have been doing much in my case, as my fasting levels weren't bad despite a high hab1c (83). Metformin helps with both post-meal and fasting levels, but it's biggest effect is with fasting levels. So I suspect it wasn't doing anything in my case. (And I changed lifestyle, so post meal levels were good due to that.)

 

[Sharron1]

Lucky you and a good surgery, if you look at my Hba1c numbers over the years, metformin (4) was never reduced until i started gently nagging. Even then any reduction came with the veiled threat, oh your Hb1c will probably increase and you will need to up metformin. I currently take 2 and after my next Hb1c, I will see what I want to do next. It is a battle and for the life of me I don't understand why. I tried to change surgeries, but they are either all full or even closing on this area.

All my bg tests are below 6 and fasting is 4ish. I believe Metformin is doing absolutely nothing for me. When I mentioned this to the HCP it didn’t go down too well. She probably thought I was a stroppy upstart, in denial and someone who knows very little! My diabetes, my research and my understanding

 

[Maz2]

I was pre-diabetic, back to normal for a few years then pre-diabetic again last year, now back to normal again.

I find my tests tend to be lower than what the hba1c comes out as but, this year, I only tested regularly for about 4 weeks and the hba1c test covers about 90 days I believe. I use the finger prick tests to check against new foods to see how well I can tolerate them and also to see if my body is still tolerating what I normally eat.

My GP and the diabetic nurse told me there is not a great deal of point in doing it and I would have to fund things myself as surgeries don't pay for the monitors and strips. I wouldn't expect struggling GPs and a struggling NHS to pay for someone like me anyway so I don't mind paying. My GPs though are only interested in what the hba1c says.

 

[Sharron1]

I test with new foods and in the morning. I know the Hba1c also looks other stuff. I do check my 90 day average on my monitor and add 3 to that number. Usually this is a closer match to the Hba1c result. Not very scientific but gives me some idea of what to expect.

 

[Maz2]

I test with new foods and in the morning. I know the Hba1c also looks other stuff. I do check my 90 day average on my monitor and add 3 to that number. Usually this is a closer match to the Hba1c result. Not very scientific but gives me some idea of what to expect.

That is a good idea. do you have one of those "continuous" ones or just the ordinary glucose monitor?