This will ruffle some feathers, but explains a lot

[Vicsetter]

Advising patients who self-monitor their blood glucose
Dr Tina Farid, a GP with an interest in diabetes, discusses which patients require self-monitoring and those who do not


This article in Pulse discusses the use of blood test monitoring for t1s and t2s:
http://www.pulsetoday.co.uk/clinica...-monitor-their-blood-glucose/20031470.article

It repeats the nice guidelines and concludes that great cost savings can be made by standardizing on a particular meter and refusing strips to T2s who are not on hypo inducing drugs.

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[Northerner]

I was going to post this yesterday but when I saw the 'premium content' thing I thought it was a paid-for registration - I usually get straight in on my free registration without needing to sign in! 🙄

So annoying! The entire emphasis is on hypos. There are some points that really give the game away:

None of those 'disadvantages' come anywhere close to comparing with the advantages - rarely painful; owning scissors could be dangerous, or knives, or pins...; may cause anxiety NOT KNOWING; people can be taught to interpret results - it's not that difficult; b****cks about calibration!; test strips are MUCH cheaper than hospital admissions and surgery. What utter nonsense! Whatever happened to treating the patient on an individual basis? I really hate this blanket approach to people - we're not cakes, we don't all come out OK if we follow the same recipe, we need to adjust according to taste! 😡 Four out of those six advantages apply to everyone, regardless of medication!!

 

[Sally71]

The final disadvantage is the real one - cost. All the rest are rubbish!
May cause pain / anxiety in some patients - yes that might be so for SOME patients; for the vast majority, probably not.
Disposal of needles can be dangerous - well yes, but how do they think people who need daily injections just to stay alive manage?! What's a sharps bin for then! Just because you aren't on insulin doesn't mean that you don't have the brains to think about these things...
May not know how to interpret results if not educated - well of course they bloody won't, so educate them then, just like you have to educate all T1s! Isn't that what doctors and dsn's are supposed to be for?! You could do classes for several people at a time to save time and money.
And most test machines don't need calibrating any more, and if they do it only takes seconds.
What a load of rubbish! You were right about it ruffling feathers

 

[Robin]

My lancet drum doesn't even have any sharp bits protruding.

 

[Diabeticliberty]

I have long held the belief that we are in the rather unfortunate position of having some doctors who appear to feel that the NHS would run perfectly smoothly providing they didn't have to deal with a particular unpleasant aspect of their job. Now what do you call them? Hang on it escapes me for the moment........erm.......now I have it - PATIENTS. While the very cheek of them plonking themselves in front of us with their whingeing, whining illnesses and coughing and spluttering their dirty germs all over us. Why the very thought of it makes me almost sick.

I also believe that the time is not too far off when the NHS will no longer fund blood testing for diabetics of any type and expect us all to self fund. I sincerely hope that I am wrong but I sincerely believe that I am right.

If you go through the list of advantages and disadvantages listed above there is one that screams out loud for all the world to hear - EMPOWERS PATIENTS TO SELF MANAGE THEIR CHRONIC DISEASE. You could build a list of disadvantages that would run end to end to the moon and back and even added together all of them cannot stand up to the big bold advantage I have highlighted.

 

[Riri]

Just pick to pick up on 1 point (I could go through them all), do they not understand that for most of us if we don't have the means to check what our blood sugars are doing, the heightened anxiety from that causes untold problems including stress with it's long term damaging effects. The long term damaging effects of running high blood sugars can cause a myriad of serious complications. Nonsense indeed.

 

[trophywench]

I agree with all of this thread so far, except the content of Madame Guillotine's message.

There are disadvantages to most things - IF YOU ARE DETERMINED TO FIND THEM.

 

[SlowRunner]

This is just my opinion but if a person with T2 is switched on enough to want to test their levels and attempt to self manage that should be encouraged, not restricted! I only know of 2 people in my family with T2 & neither of them are at all interested.

My uncle has had it for years, suffers with high blood pressure, leg ulcers and is nearly blind. He has been a huge drain on NHS funds for many years due to the tablets he's on & the complications he has. He has never shown the slightest bit of interest in helping himself (other than to sweets & cakes!!).

My mum was diagnosed only recently and is only just in the diabetic range so is currently managing with diet & exercise. Unfortunately she has taken the stance that the nurse at her practice knows what she is talking about when she said there was no need for her to self monitor, & has also only been warned about high sugar foods so is still quite happily munching bread, rice, pasta, bananas, etc. and has no idea what any of this is doing to her. She doesn't want to test either & says she feels sorry for me having to test all the time!

So I would have thought that a T2 with an interest in actually looking after their own health would be a breath of fresh air!

 

[pottersusan]

It makes me want to SCREAM.

we're not cakes, we don't all come out OK if we follow the same recipe, we need to adjust according to taste! !

You obviously haven't eaten my cakes... same recipe - different results😱. my excuse is I rarely bake a cake these days.

 

[Sally71]

Loving all your replies

And of course I forgot to add onto my earlier post that the cost of strips is a bit of a non-issue when you compare it with the cost of dealing with (largely avoidable) diabetic complications; unfortunately the people who hold the purse strings can't see beyond the next audit 😡
In fact I reckon they've made all these disadvantages up just to try to hide the fact that they are only bothered about short term financial savings.

Think I'll go and bang my head against a wall now, reading all this sort of thing makes me really annoyed!

 

[Vicsetter]

Told you!!!
I might add that there is no suggestion that an hba1c is taken every 3 months because that is all it measures!

 

[everydayupsanddowns]

Here's something interesting I found out this year... The majority of the cases (and attendant expenditure) for Severe Hypos does not come from errant adolescent T1s, or struggling parents with very young and unpredictable T1 children... no. The vast majority are elderly people living with T2 who are on insulin or oral hypoglycaemics.

And yet... by not allowing people to measure and understand their bodies and how they react to carbs with test strips there are a host of people who are propelled mercillessly through the GP ticksheet onto more and more meds and ultimately insulin. We have several members here who have been able to reduce or avoid the need for such meds - and others who (because they DID self monitor) were much better prepared to add medication in a more personalised way.

I completely agree with Northie's destruction of the nonsense of that table, and the people who wrote that should take a long hard look at this study. Unstructured occasional BG tests (as are most often advised) are useless. People need to be given test-review-adjust education and treated as intelligent individuals.

https://www.mja.com.au/journal/2015...sely-when-it-comes-monitoring-type-2-diabetes

Bah!! 😡🙄

 

[Mark Parrott]

Advantages of testing: Everything
Disadvantages of testing: None

 

[Northerner]

Advantages of testing: Everything
Disadvantages of testing: None

And if ever proof were needed Mark, you're it! 🙂

 

[Vicsetter]

Referred to in that Pulse article is this Oxford based study: http://www.bmj.com/content/335/7611/132
A further reference is to another article (http://www.idf.org/webdata/docs/SMBG_EN2.pdf) from the International Diabetes Federation (never heard of them!). which concludes:

SMBG (Self Monitoring of Blood Glucose) should be used only when individuals with diabetes (and/or their care-givers) and/or their healthcare providers have the knowledge, skills and willingness to incorporate SMBG monitoring and therapy adjustment into their
diabetes care plan in order to attain agreed treatment goals.

Which about sums it up, SBMG is no use if your GP or you are a numpty!!

 

[LeeGee]

One thing I've often wondered, is why the NHS doesn't use it's massive buying power to procure test strips that we can then buy at cost price. They'd cost around a tenth of the price on the high street and we wouldn't need to ask for freebies.

 

[Northerner]

One thing I've often wondered, is why the NHS doesn't use it's massive buying power to procure test strips that we can then buy at cost price. They'd cost around a tenth of the price on the high street and we wouldn't need to ask for freebies.

The NHS do have deal with suppliers, I think most of the major brands have been negotiated down to around £15 for 50 strips. Of course, now they are doing exclusive deals with cheap, lesser-known manufacturers so getting a better deal on them. It's all a bit of a red herring though, as the money spent on treatment for preventable complications far exceeds the cost of strips (they spend around 50 times as much 😱)

 

[LeeGee]

I think they can do better than that. I had two NHS hearing aids a few months ago. I asked the guy how much they would have been private. He said £2500. I said I felt really guilty costing the NHS that much. He said not to worry as the NHS gets them for £70. Mind you he did say they purchased them at a million units per order. That's buying power for you.

 

[everydayupsanddowns]

Referred to in that Pulse article is this Oxford based study: http://www.bmj.com/content/335/7611/132
A further reference is to another article (http://www.idf.org/webdata/docs/SMBG_EN2.pdf) from the International Diabetes Federation (never heard of them!). which concludes:
Which about sums it up, SBMG is no use if your GP or you are a numpty!!

I have heard Andrew Farmer (author of that first paper) talk and he has looked at T2 testing more than once, but seems to have decided that it doesn't work. He did concede in a question that it is an option for 'some individuals' but the way he has constructed his studies has repeatedly shown that SMBG doesn't work. I've not looked at this one in detail, but often there is mention of 'adherence' to a supplied dietary plan, rather than using results to formulate an individualised low-spike menu based on how a person responds to food.

 

[KookyCat]

Ahem, now I might be being a total dullard but are we saying that on the basis of that cost benefit analysis they conclude people with type 2 shouldn't test?

So,
1. Teach them how to do it properly and it won't hurt
2. Give them a sharps bin
3. Tell them what to do about the results so anxiety is lessened
4. As above
5. Tosh, but if I must dignify it with an answer, then calibrate the meter, three seconds job done
6. Tot up and tell us the cost of complications of diabetes, think for 2 seconds....there it is.

Right so that's the disadvantages sorted, the advantages look good, so let's go, get everyone the test strips and jobs a good un. Ooh and look I didn't need 7 years of medical school to come up with those gems.

Incandescent with rage is becoming my natural home 😡