I was quite surprised to be told by the nurse at the GP surgery carrying out my annual review: "Very few Type 1 diabetics test more than twice a day". The next day at a DAFNE follow-up session, the trainer seemed horrified at the suggestion, and others round the table seemed equally surprised. One who drove as part of his job said that six tests were quite normal for him. Type 1 since 1981, when we had to pay for test strips and disposable needles, I have averaged 4+ tests a day. I am not sure I believe the nurse's statement. Can anyone point me towards the evidence on which she based it?
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Type 1 only testing twice a day?
- Thread starter JohnWhi
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Robin
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The NICE guidelines say nurses should be encouraging their Type 1s to test 'at least' 4 times a day, and up to 10 times a day if circumstances dictate.
https://www.nice.org.uk/guidance/ng17/chapter/1-Recommendations#blood-glucose-management-2
So no, I don’t know where she got her evidence from, and I wonder when she last read the NICE guidelines!
Ljc
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- Type 1.5 LADA
OMG I am horrified too,
That nurse needs some re training . How on earth can you work out your mealtime units and corrections without testing, if you drive their are the DVLA rules . Before I stated using the Libre I was testing around 6 times a day
No don’t listen to her re the testing
That nurse needs some re training . How on earth can you work out your mealtime units and corrections without testing, if you drive their are the DVLA rules . Before I stated using the Libre I was testing around 6 times a day
No don’t listen to her re the testing
rebrascora
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I would go so far as to say that testing just twice a day is neglecting your diabetes management and even without taking into consideration the tests needed to drive or to ensure your safety when exercising or when hypo, 2 a day does not give you enough info to calculate insulin requirements.
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I think there are 2 things here (which may have led to the nurses comment (confusion?).
NICE (and DAFNE and other diabetes management courses) suggest a minimum of 4x a day. In fact, NICE carried out a health economics analysis and found that 2x a day was not cost effective because of the increased risk.
but...
In reality the average testing frequency in the overall UK T1 population is very low. And is less than 2x a day.
That doesn’t mean that’s a good thing though!!
NICE (and DAFNE and other diabetes management courses) suggest a minimum of 4x a day. In fact, NICE carried out a health economics analysis and found that 2x a day was not cost effective because of the increased risk.
but...
In reality the average testing frequency in the overall UK T1 population is very low. And is less than 2x a day.
That doesn’t mean that’s a good thing though!!
MrDaibetes
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I was always encouraged to test 4x a day. This would be morning, afternoon, tea and bed.
Sally71
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- Parent of person with diabetes
My mum doesn't test very often, and some days not at all, and has sometimes hinted that she thinks we test far too often! I have tried to explain to her why we test as often as we do, i.e. to calculate insulin boluses and because we are on a pump we have to be on the ball in case of cannula failures and so on, so that we can pick up problems before they reach danger levels. But I don't think she understands, and I actually think we test the bare minimum for pumpers (in the beginning was sometimes only mealtimes and bedtime and then only in between if things seemed wrong, this has improved since we got the Libre because it's so easy to scan!).
To be fair to my mum, she was diagnosed in 1967 when home blood testing kits didn’t exist, all she had to rely on were urine sticks (which don't tell you much) and her own perception of how she felt, so I think testing to her is more of a luxury than a necessity. She only takes fixed doses of insulin and I think is very much a creature of habit regarding food so probably knows how much carbohydrate she can eat on those doses. Whether anyone has ever suggested carb counting to her, or whether they did and she didn’t want to do it, I don't know, I suspect she's not keen on learning a whole new way of doing things. I do know that the doctor suggested that maybe splitting her Levemir dose would keep her more stable and she basically told him to get lost because four injections a day is enough! She is managing her diabetes the way she understands and says she is happy with her control; her hba1c is higher than my daughter's though, and she seems to think it's inevitable that your blood sugars are going to bounce around a lot and has developed the attitude that “you can't control your diabetes tightly all the time therefore you might as well not bother trying”, not an attitude I really want my daughter having in any aspect of her life, and I know her consultant would go up the wall if we were as lax about it as mum is! At my mum's age (mid-70s) maybe it doesn't matter so much, and she's been dealing with diabetes longer than I’ve been alive, so I don't think I really have the right to tell her how to manage her own medical condition. We've been taught different ways though and have the benefit of better knowledge and technology, and I want my daughter to have the best possible chance of a long life with no complications, so I will continue doing what we are doing.
I am aware that there are people who have had diabetes as long as my mum who have happily embraced carb counting and pumps and so on; my mum is a bit of a technophobe though and doesn't like change, she's dealing with her diabetes the way she knows how, is happy just doing her four jabs a day and the occasional test and feels confident that most of the time she is able to judge whether she feels low or high and doesn't feel the need to have to test all the time just to prove what she knows anyway. I've also tried to explain that that might work for her, but I don't know what my daughter feels like do I, and we have had false alarms so I like to test to make sure; not sure she understood that either! (Or maybe she thinks I’m trying to tell her that I think she should test more often or that we are doing it better or something, which is not what I want to say to her at all, we're both just trying to deal with a complicated condition the best way we know how)
Sorry for the long ramble, but basically it's up to you how often you test; if you want the very best control though then you need to know what your blood sugars are doing and the only way you can know that for sure is by testing, twice a day is definitely not enough if you are trying to maintain tight control!
To be fair to my mum, she was diagnosed in 1967 when home blood testing kits didn’t exist, all she had to rely on were urine sticks (which don't tell you much) and her own perception of how she felt, so I think testing to her is more of a luxury than a necessity. She only takes fixed doses of insulin and I think is very much a creature of habit regarding food so probably knows how much carbohydrate she can eat on those doses. Whether anyone has ever suggested carb counting to her, or whether they did and she didn’t want to do it, I don't know, I suspect she's not keen on learning a whole new way of doing things. I do know that the doctor suggested that maybe splitting her Levemir dose would keep her more stable and she basically told him to get lost because four injections a day is enough! She is managing her diabetes the way she understands and says she is happy with her control; her hba1c is higher than my daughter's though, and she seems to think it's inevitable that your blood sugars are going to bounce around a lot and has developed the attitude that “you can't control your diabetes tightly all the time therefore you might as well not bother trying”, not an attitude I really want my daughter having in any aspect of her life, and I know her consultant would go up the wall if we were as lax about it as mum is! At my mum's age (mid-70s) maybe it doesn't matter so much, and she's been dealing with diabetes longer than I’ve been alive, so I don't think I really have the right to tell her how to manage her own medical condition. We've been taught different ways though and have the benefit of better knowledge and technology, and I want my daughter to have the best possible chance of a long life with no complications, so I will continue doing what we are doing.
I am aware that there are people who have had diabetes as long as my mum who have happily embraced carb counting and pumps and so on; my mum is a bit of a technophobe though and doesn't like change, she's dealing with her diabetes the way she knows how, is happy just doing her four jabs a day and the occasional test and feels confident that most of the time she is able to judge whether she feels low or high and doesn't feel the need to have to test all the time just to prove what she knows anyway. I've also tried to explain that that might work for her, but I don't know what my daughter feels like do I, and we have had false alarms so I like to test to make sure; not sure she understood that either! (Or maybe she thinks I’m trying to tell her that I think she should test more often or that we are doing it better or something, which is not what I want to say to her at all, we're both just trying to deal with a complicated condition the best way we know how)
Sorry for the long ramble, but basically it's up to you how often you test; if you want the very best control though then you need to know what your blood sugars are doing and the only way you can know that for sure is by testing, twice a day is definitely not enough if you are trying to maintain tight control!
trophywench
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- Relationship to Diabetes
- Type 1
A surgery nurse is not an expert on dealing with diabetes of ANY Type - neither is a GP and should not ever claim to be one. I well remember being asked by a hospital DSN who treats your diabetes ? Well the only correct answer to that question all along is always 'ME!' Yeah OK so we get advice from various folk, some of whom are medics, and we can choose which advice we accept and follow - but up the sharp end, we always have to do it ourselves!
emmgeo
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- Type 2
When I was on insulin I was testing at least 8 times a day, first thing in the morning then at tea break, two hours after that then at lunch break, then two hours after that then at tea time then two hours after that then at bed time.
I would also test before driving and then two hours into the drive. as well.
I am no longer on insulin but still test at least three times a day, first thing in the morning then at tea time and two hours after.
I hope I never have to go back on to insulin now that I know what is involved with being on it, but being a type 2 Diabetic I know that it may happen again one day.
I would also test before driving and then two hours into the drive. as well.
I am no longer on insulin but still test at least three times a day, first thing in the morning then at tea time and two hours after.
I hope I never have to go back on to insulin now that I know what is involved with being on it, but being a type 2 Diabetic I know that it may happen again one day.
Amity Island
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- Type 1
John,
If you'd have mentioned that question before I started using the Freestyle Libre last year (seeing how my blood sugar actually changes from minute to minute), i'd of said test no less than 6 times a day. However, knowing what I know now, I should of really been testing much more. The advice up until recently from the specialists was always to test upon waking, before each meal and before bed (plus after hypos, basal tests, 3am test etc). This however, never showed the peaks and lows you can get in between meals.
Now when I go for a diabetes review at hospital, their advice has completely changed
, they've started looking at the peaks in between meals! (something they never even thought about or advised on before). The continuous output on the Freestyle Libre has completely changed the way I eat, insulin doses, insulin ratios, timings etc.
"No more than 2 finger prick tests a day" is wholly inadequate, quite dangerous really, in the short term and the long term management of type 1 diabetes. I've said this before, I think newly diagnosed type 1's should all be offered Libre for a min of 6 months to get a grasp of everything, ideally on a permanent basis if they want it.🙂
If you'd have mentioned that question before I started using the Freestyle Libre last year (seeing how my blood sugar actually changes from minute to minute), i'd of said test no less than 6 times a day. However, knowing what I know now, I should of really been testing much more. The advice up until recently from the specialists was always to test upon waking, before each meal and before bed (plus after hypos, basal tests, 3am test etc). This however, never showed the peaks and lows you can get in between meals.
Now when I go for a diabetes review at hospital, their advice has completely changed
, they've started looking at the peaks in between meals! (something they never even thought about or advised on before). The continuous output on the Freestyle Libre has completely changed the way I eat, insulin doses, insulin ratios, timings etc. "No more than 2 finger prick tests a day" is wholly inadequate, quite dangerous really, in the short term and the long term management of type 1 diabetes. I've said this before, I think newly diagnosed type 1's should all be offered Libre for a min of 6 months to get a grasp of everything, ideally on a permanent basis if they want it.🙂
Amity Island
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- Type 1
In reality the average testing frequency in the overall UK T1 population is very low. And is less than 2x a day.
Interesting fact that Mike!, a very surprising one as well, which makes the nurses statement correct!😱
Interesting fact that Mike!, a very surprising one as well, which makes the nurses statement correct!😱
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- Relationship to Diabetes
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Can’t really read this on my phone and it mixes T1 and T2 but the median frequency of all included people was 600 per year I think - so 1.6 per day
https://www.ncbi.nlm.nih.gov/m/pubmed/24359593/
Amity Island
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- Type 1
So the nurse was correct! "Very few Type 1 diabetics test more than twice a day".
but like you say, this is a statistic and by no means good advice. It's funny how people can take things out of context. Nurse read somewhere that "Very few Type 1 diabetics test more than twice a day" or the nurse has drawn this conclusion from her own experience, next thing you know, she's giving this out as advice!!!
Like twice a day is the benchmark of good management😱....Bruce Stephens
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Seems to be about T1 and insulin treated T2. I'm not sure what the numbers on that would be, but the conclusion is "Although the data did not capture the glucose frequency comprehensively, it varied significantly by insulin types, and was higher than what is recommended in the guidelines for patients with type 2 diabetes." which suggests they consider the trial mostly about T2.
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Yes exactly. There were a number of people on mixed or basal only included. I’ll try to see if they stratified for Basal:Bolus / MDI as that would be a better population to examine.
Very many thanks to all for the responses and suggestions. The NICE guidelines are a useful reference point when the subject is next raised. The suggestion that GPs and practice nurses may not be experts on Type 1 rings true. When I came to the practice in 2012, they were very difficult about allowing me access to a hospital diabetic clinic: "There is no need, we do all that here". Following some potentially dangerous advice, I put in an official complaint to the predecessor of the CCG and was eventually referred to an excellent hospital diabetes centre. Apart from sending a letter to the GP practice to the effect that I might need to test up to six times a day, over the years they have moved me to pump therapy and now Freestyle Libre sensors on prescription, until the money runs out. So the question of the amount of finger-prick testing has become an academic point rather than a practical anxiety.
trophywench
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- Type 1
Well - I never expect em to be experts in any condition disease or complaint - how the hell could they possibly be? No person possibly ever could so it would be entirely unreasonable of me to! However what I wish they would ALL do is learn enough about all sorts of things to be able to recognise when they are out of their depth and hence refer patients on to wherever they really need to be. However - such pressures - financial and psychological - are brought upon GP surgeries these days NOT to refer people to hospital as a matter of course whenever they present with X, Y or Z - then of course they'll try not to.
In a lot of ways, with such a lot of conditions being firmly sent back to the GP as soon as the hospital can get rid of it - I feel very relieved I'm using a pump since - so far at least - no GP surgery has that expertise!
In a lot of ways, with such a lot of conditions being firmly sent back to the GP as soon as the hospital can get rid of it - I feel very relieved I'm using a pump since - so far at least - no GP surgery has that expertise!
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