Diabetes testing question

[homemommy83]

I was diagnosed borderline gestational diabetic with the last 2 pregnancies and so I have been testing myself with this new pregnancy to make sure all stays well.  I never had high readings with either of the 2 pregnancies, but it was because I managed it with diet and exercise not because I wasn't intolerant...kwim. 

Yesterday after dinner I began testing my glucose level and a family member that has had diabetes for the last several years goes "what is that?" so I explained it was a glucose meter and that I test myself every morning and after every meal to make sure that my numbers stay healthy.  She then went on that she has never tested herself and that the doctor just gives her pills and checks her a1c yearly and adjusts the medicine by those numbers.  She was offered insulin, but has chosen to wait and I totally understand avoiding any unnecessary medications.  But I find it terribly odd that a doctor would not encourage a diabetic to routinely take their blood glucose levels regularly.

  I politely encouraged this person that checking ones glucose levels allows them to understand how different foods affects them personally and whether morning intolerance issues are an issue...as they are with me.  

Am I the only one who finds it odd that a diabetic isn't being counseled to check their glucose or is this the way diabetes is being treated...by only a1c levels and medication?

 

Brenda

[readinmom]

No, you have a right to be concerned.  It's standard practice to check a1c every 3 months once diagnosed, to monitor meds, effectiveness, etc.  

[Jean in Newcastle]

Her doctor is seriously out of line, in my opinion.  I doubt that her diabetes is being well controlled.  For one thing, by the time you get the A1C, it is measuring what has been happening for the last three months.  Plus, if she's been offered insulin, then her A1C must be fairly high (at least in my experience). 

[homemommy83]

Her A1c was 7, but she said that it was down from before so she was happy.  I know 7 isn't good, but I am happy it is lower than before.  

Brenda

 

 

[Jean in Newcastle]

Depending on where she lives, she could ask to meet with a diabetic educator.  They work with patients to explain the testing process, food choices esp. things related to carbohydrates, and portion control.  I have never known of a doctor to refuse to send someone to see one if they are asked.  (But I also live in an urban area where there is good access to professionals like this.) 

[homemommy83]

2 minutes ago, Jean in Newcastle said:

Depending on where she lives, she could ask to meet with a diabetic educator.  They work with patients to explain the testing process, food choices esp. things related to carbohydrates, and portion control.  I have never known of a doctor to refuse to send someone to see one if they are asked.  (But I also live in an urban area where there is good access to professionals like this.) 

I think this would be a great thing for her, but she was resistant to my idea of testing herself...or honestly anything I would suggest to her in regards to this...I think she prefers to not think about making changes at all sadly. 

I watched my father die a slow death in and out of the hospital for numbers above 700 repeatedly (causing heart attacks and his foot to rot off) so I have taken this seriously as I never would want my children to have to endure watching me slowly get sicker and sicker.  My kids are already seeing an aunt get more and more ill due to not watching her glucose levels...she has everything...neuropathy, kidney failure, and heart disease-and had open heart 15 years ago.  The lady I spoke of in this post is her sister so I know she understands the seriousness of this disease, so I am so confused why her doctor just doesn't seem as concerned as I am.  Her mother died from diabetes complications as well so she has now seen two close family members fight this disease, so it makes me wonder if she is too frightened to work on the disease as she may feel it is hopeless.

Brenda

[Jean in Newcastle]

4 minutes ago, homemommy83 said:

I think this would be a great thing for her, but she was resistant to my idea of testing herself...or honestly anything I would suggest to her in regards to this...I think she prefers to not think about making changes at all sadly. 

I watched my father die a slow death in and out of the hospital for numbers above 700 repeatedly (causing heart attacks and his foot to rot off) so I have taken this seriously as I never would want my children to have to endure watching me slowly get sicker and sicker.  My kids are already seeing an aunt get more and more ill due to not watching her glucose levels...she has everything...neuropathy, kidney failure, and heart disease-and had open heart 15 years ago.  The lady I spoke of in this post is her sister so I know she understands the seriousness of this disease, so I am so confused why her doctor just doesn't seem as concerned as I am.  Her mother died from diabetes complications as well so she has now seen two close family members fight this disease, so it makes me wonder if she is too frightened to work on the disease as she may feel it is hopeless.

Brenda

I hear you.  MIL had totally uncontrolled diabetes and she was a nurse and should have known better. 

[AK_Mom4]

Or...gently.... your relative WAS counciled about testing, didn’t like what they heard, and ignored it.

I see my diabetes doc every 3 months for follow up and he LOVES seeing me.  Why? Because I actually DO the work to control my diabetes and follow his recommendations.  I had gestational diabetes with kid #4, managed to hold everything at bay for 10 years with diet, exercise and 1 pill.  These days, I am insulin-dependent.  But as a patient, my doc tells me I am the exception rather than the rule.  Most people don’t want to put in the work day after day, year after year, forever.  It’s hard.

My belief is that people don’t like to test because it means admitting they have a disease that isn’t going away.  That and the shaming from society because Type 2 diabetics are all fat and lazy and we wouldn’t be diabetic if we just had some self control.

Bleah - now I’m all grumpy.  OP - I’m glad you are testing and monitoring.  I’ve been down that road and it’s no fun, but hang in there.  The healthy baby and a pancreas that still likes you make it all worth while.

[Katy]

If she was on insulin the testing would be non-negotiable.  But as someone who refuses it, the most current thinking IS to only do quarterly testing, because multiple studies show that using medicine for tighter control is more likely to lead to death.

As long as this relative knows that weight loss and exercise will make a big difference but isn't willing to make changes there, unfortunately the evidence is that just closer monitoring and more medications won't help.

[homemommy83]

2 hours ago, Katy said:

If she was on insulin the testing would be non-negotiable.  But as someone who refuses it, the most current thinking IS to only do quarterly testing, because multiple studies show that using medicine for tighter control is more likely to lead to death.

As long as this relative knows that weight loss and exercise will make a big difference but isn't willing to make changes there, unfortunately the evidence is that just closer monitoring and more medications won't help.

Yes, this is what I have seen as well in studies for insulin and diabetes.  

Brenda

[Bootsie]

https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1001%2Fjamainternmed.2017.1233

This recent study suggests, that at least for some with Type 2 diabetes who are not on insulin, daily testing is not necessary or helpful.

[Pegasus]

Not all doctors are well equipped to manage diabetic patients. The totality of my doctor’s guidance upon my diagnosis as a diabetic was to eat fewer calories, increase exercise, and take this pill (500 mg metformin ER daily). He actually said that he didn’t think monitoring my blood glucose at home would be “productive.” I told him that I was motivated to make the necessary diet and exercise changes. He said that those things are hard to do. Wanting more guidance on what to eat, I mentioned that I was learning how to count carbs and asked about a referral to a dietician. He said that he wanted to see what I could do on my own first and to come back in 6 months. Ummm. . .what can I do on my own with no guidance, no map, no compass, and no defined destination?

I was motivated. I did my own research. I soon abandoned the metformin and changed the way I ate. I used home monitoring of my blood glucose to guide my actions.  My next A1C was 5.3 and my doctor was thrilled. He stated that he almost never saw improvements like that (I wonder why, with the stellar guidance that he provides) and wanted to know what I was doing.  He quickly cut me off as I started to describe how I was monitoring my blood glucose levels closely and changing the way I eat accordingly.  He asked if I was still measuring my blood glucose and stated that he just didn't think that was necessary. He considered me "cured" of diabetes, which is ridiculous.  If I eat a "typical" meal, my glucose level would spike well above normal/healthy.  My following A1C was 4.8 and he only remarked, rather coldly, that it had "dropped again."  

 

 

 

[Pegasus]

10 minutes ago, jdahlquist said:

https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1001%2Fjamainternmed.2017.1233

This recent study suggests, that at least for some with Type 2 diabetes who are not on insulin, daily testing is not necessary or helpful.

 

Ugh!  The patients instructed to do self monitoring were testing once per day!  Of course that didn't prove helpful.  That's like assigning one group to walk to the  mailbox once per week and wondering why their fitness didn't improve over a group that sat on the couch.  Self monitoring, especially at first, needs to be done frequently: upon waking, before each meal, one hour after each meal, two hours after each meal, before bedtime. This is the only way to really monitor how different foods and amounts, etc. affect their blood glucose levels.  This is only helpful if they are willing to change the way they eat.  Once a day testing would be useless regardless of motivation.  

[homemommy83]

15 hours ago, Pegasus said:

Not all doctors are well equipped to manage diabetic patients. The totality of my doctor’s guidance upon my diagnosis as a diabetic was to eat fewer calories, increase exercise, and take this pill (500 mg metformin ER daily). He actually said that he didn’t think monitoring my blood glucose at home would be “productive.” I told him that I was motivated to make the necessary diet and exercise changes. He said that those things are hard to do. Wanting more guidance on what to eat, I mentioned that I was learning how to count carbs and asked about a referral to a dietician. He said that he wanted to see what I could do on my own first and to come back in 6 months. Ummm. . .what can I do on my own with no guidance, no map, no compass, and no defined destination?

I was motivated. I did my own research. I soon abandoned the metformin and changed the way I ate. I used home monitoring of my blood glucose to guide my actions.  My next A1C was 5.3 and my doctor was thrilled. He stated that he almost never saw improvements like that (I wonder why, with the stellar guidance that he provides) and wanted to know what I was doing.  He quickly cut me off as I started to describe how I was monitoring my blood glucose levels closely and changing the way I eat accordingly.  He asked if I was still measuring my blood glucose and stated that he just didn't think that was necessary. He considered me "cured" of diabetes, which is ridiculous.  If I eat a "typical" meal, my glucose level would spike well above normal/healthy.  My following A1C was 4.8 and he only remarked, rather coldly, that it had "dropped again."  

 

 

 

 

I am proud of how much work you put into your diagnoses and treatment, but it is sad that the doctor only saw medicine as the answer before giving a dietician recommendation. 

I know with gestational that the focus is diet...sadly however with the body changing so widely when expecting one may tolerate a meal today, but not the next week.

[homemommy83]

15 hours ago, Pegasus said:

 

Ugh!  The patients instructed to do self monitoring were testing once per day!  Of course that didn't prove helpful.  That's like assigning one group to walk to the  mailbox once per week and wondering why their fitness didn't improve over a group that sat on the couch.  Self monitoring, especially at first, needs to be done frequently: upon waking, before each meal, one hour after each meal, two hours after each meal, before bedtime. This is the only way to really monitor how different foods and amounts, etc. affect their blood glucose levels.  This is only helpful if they are willing to change the way they eat.  Once a day testing would be useless regardless of motivation.  

This is exactly the truth as I have personally seen in my own testing.  A person needs to see their patterns throughout the day and see which foods are their trigger foods and for how high.  It may shock them that half a cup of cereal with a tad of milk runs their sugar 160, but potatoes and steak keep it low.

 

[Jean in Newcastle]

I am in a fight right now with my doctor (or more likely the insurance company that he is dealing with).  I have a prescription that allows for testing twice a day.  I finally talked him into giving me a one month prescription for testing 4x a day.  I don't know if I will win the fight to be able to continue testing that much but I need it.  There are so many variables affecting bloodsugar beyond just carb count  for me - inflammation, illness to name just a couple. 

[homemommy83]

1 hour ago, Jean in Newcastle said:

I am in a fight right now with my doctor (or more likely the insurance company that he is dealing with).  I have a prescription that allows for testing twice a day.  I finally talked him into giving me a one month prescription for testing 4x a day.  I don't know if I will win the fight to be able to continue testing that much but I need it.  There are so many variables affecting bloodsugar beyond just carb count  for me - inflammation, illness to name just a couple. 

I am using a Relion Prime set as a friend gave it to me and the strips are 10 dollars for 50...so you may ask if your insurance will give you a better meter with less cost per strip....this has been amazing for me.  My meter I had was 80 dollars for 50 strips!  So there is a great variance in cost.  So it would cost about 40 dollars to do a solid month of testing to see what affects you personally.

 

[Pegasus]

4 hours ago, Jean in Newcastle said:

I am in a fight right now with my doctor (or more likely the insurance company that he is dealing with).  I have a prescription that allows for testing twice a day.  I finally talked him into giving me a one month prescription for testing 4x a day.  I don't know if I will win the fight to be able to continue testing that much but I need it.  There are so many variables affecting bloodsugar beyond just carb count  for me - inflammation, illness to name just a couple. 

 

Yes, you are absolutely correct. It is not just food that affects blood sugar. There are decent inexpensive monitors and strips available. I get mine from Amazon.  A prescription is not needed. I'm currently using a Bayer Contour but have used a Wavesense Presto and a TRUEresult monitor.  You are better off pricing by the ongoing cost of the strips, even if you have to pay a little more for the meter.