Type 2 Diabetes and Daily Blood Sugar Monitoring

Hi! Like this episode? We’ve made some other HCT Episodes on Diabetes, if you want check them out:
1. YMCA and the Diabetes Prevention Program: https://www.youtube.com/watch?v=mR77alFcekw
2. The Effectiveness of Screening and Treating Diabetes: https://www.youtube.com/watch?v=kLCI58lbqcE

Ok. So my argument is that once per day is NOT ENOUGH for Type 2 Diabetes, at least at the beginning. A large part of the treatment for Type 2 Diabetes is diet and exercise. In order to understand the effect of these on blood glucose properly, much MORE glucose testing is needed, or even use of a continuous glucose monitoring system. This type of treatment does not need to be forever, but for a few months so patients can understand the link between their actions, and their blood glucose.

Also, I know you were trying to be reasonable and balanced when talking about the trade off between different types of care, and bringing up the high cost of insulin for those who take it. The issue there is NOT the lack of funding for insulin, but the outrageous price charged for a drug that is MUCH cheaper to produce. Diabetics will do what they can to pay for insulin, regardless of the cost, because without which many of us would not survive.

Fifty-ish years ago when far less was known about diabetes care, my mother was put in the hospital for observation while they allowed her to go into the too low blood sugar zone so that she could know how her body behaved in that situation. She found it useful, but I can’t imagine them doing that to a patient today!

I don’t know how much I agree with this, but I will say that, aside from when I first got diagnosed, no, I don’t test every day or even once a week somtimes. It’s a matter of learning how your body reacts to what, though, and that’s where I feel like the glucometer is super important. That first year I had diabetes, I really needed my glucometer because I couldn’t tell how it felt to have low sugar vs high sugar, or what made me sick, etc. Now I know all my rhythms pretty well, but every once in a while I do some routine tests with my glucometer to make sure I’m still doing stuff right. And sometimes, after tracking it for about a week or two, I realize that either, hey, I’m doing something right or crap, I need to figure out what’s making my sugar too high or too low.

i think this video was more referring to T2DM which is generally not so insulin dependent, so it helps if they don’t need to take and can control it with diet and exercise. type 1 is a vastly different story, requiring regular sugar checks and insulin administration

@Jordyn I think you are correct. I think my point was that the trade off between monitoring and insulin costs (regardless of type of Diabetes) was a spurious one. The issue with affordability of insulin is NOT lack of funding, but exhorbitant prices.

As someone interning in a diabetes clinic, that caveat “type 2 diabetes NOT ON INSULIN” is pretty crucial. Testing more than once a day is a waste ONLY if the patient is stable and well-controlled on all their medications and none of those medications are insulin. Any changes to the insulin dosing really need monitoring of more than once a day to assess the effects.

But yes, if patients get to where they’re stable, controlled, and not on insulin, they don’t need to test more than a few times a week, if that.

I have Type 2 Diabetes.

I was put on a (government funded) diabetes management program, which involved, amongst other things, for the first month or so, testing my blood glucose level multiple times a day:
– When I woke up.
– Just before a meal.
– 2 hours after a meal.
– Before I went to bed.

I found it really useful having direct feedback about the food I was eating. Rather than choosing foods for some vague benefit in the future, I had an immediate measure about its effect on me. Through this process I figured out that (amongst other things):
– Foods labelled “Low GI” are fine.
– Foods with low carbohydrate and sugar levels are probably ok.
– Foods with high carbohydrate and/or sugar levels are real bad.
– Eating too much in one meal is bad.
– Not eating for too long is bad.
– If I have been doing heavy exercise, it doesn’t matter much what I eat.

I now only test my blood if I do something different, like go to a restaurant I haven’t been to before (and would consider returning). I also have to convince my GP that I’m using the tests responsibly to continue getting a government subsidy on the testing strips.

It’s been a couple of years now and, so far, I have no observable symptoms (other than blood tests).

I realise I am only one data point and I can’t re-run the experiment without the self-administered blood tests, but I think it would be a real shame if those of us that can demonstrate we are using the tests responsibly, don’t have ready access to them.

I completely disagree with the research on this. I’m type 2 and I now have continuous blood sugar monitoring (Libre Freestyle, love it) and it has made an huge difference in my care and my overall blood sugar. Without being able to see realtime and continuously how what I’m doing affects my blood sugar I wouldn’t have made some of the changes I’ve made to my diet. I understand that a lot of type 2 people have a hard time changing their diets and that it’s quite likely that testing isn’t affecting their motivation to change their diets, but that’s not a reason to stop testing.

Oh, No. A credentialed professional looks at verified data and tells the truth. Thanks again Aaron. I live in Newark, NJ, USA and if you want to see the market in “test strip loosies”, come here. You can sell them in batches of 10 to 50 but buy them at an inflated price in singles . None of the authorities here knows how to stop it or even if it is not legal. This is NJ it may not be illegal. Some old black guy can be killed by Staten Island police for selling single cigarettes but the open advertising to purchase (and by implication, re sell) single diabetes test strips is overlooked. Come to Newark and I’ll show you

Doctor, was any similar tests conducted for monitoring blood pressure as well?

As always, a great breakdown of a very important health issue!
I want to point out some things about the Monitor trial:
Patients in all three arms had pretty low A1cs at baseline (at least compared to my patients), and the vast majority of patients have had diabetes for >1 year at baseline.
Like you said, it’s not news that SMBG does not significantly improve outcomes in patients like these.
However, the patients that were underrepresented are those with very uncontrolled diabetes (but still non-insulin dependent), and those newly diagnosed. These patients most definitely need to be followed very closely.
Also notice how the two SMBG arms were in the controlled range until month 6, then suffered a slight increase by month 9, and then BAM! Back to baseline at month 12!
I think this is the largest highlight of the study – that no matter what we do, patients might do great in the first few months after an intervention, but then suffer disease fatigue and regress back to baseline (this is touched upon by the authors in this trial, which is great).
This showcases the importance of keeping up with patients and making sure they’re not burning themselves out – diabetes is an entire lifestyle change, which can be very mentally challenging (the anecdotal new year’s resolution failure).
That’s the biggest take-away from the study. Not the fact that SMBG in slightly poorly controlled, long-standing diabetes is useless in the long run (12 months). Rather, it’s the fact that all patients suffer from some form of fatigue and need to be on our radar in some way (which will reduce healthcare costs in return).

Yes, I think that providing the patient is of insulin and well controlled, you are absolutely right. However, I would like to say that as someone who found out in September 2018 that I had type 2 by ending up in the hospital with DKA and a blood sugar of 823, my glucometer was crucial the first three months. I showed up at the hospital with an A1C of 15 and with a combination of insulin, Lantus, Metformin, and diet, I showed up at my doctor’s office three months later with an A1C of 6.3. That would have been impossible without constant monitoring those first months. I tested 7 times a day during that time. Seems excessive, I know. But I needed that at first to find out what affected me how. As a result after those first three months I know what to eat when and no longer take insulin or Lantus. At my last visit my doctor halved my Metformin and told me to test only if I felt I needed to. I agree that once you get control you can lay off. But I also think that sometimes doctors are not aggressive enough about getting that initial control. I had to fight tooth and nail to eat the diet I chose, they thought it was too low in carbs, too keep taking insulin after I left the hospital, my insurance company didn’t want to pay, they said I didn’t need it or the Lantus. Each patient is different and requires different levels of guidance. I just wish that the insurance companies would follow the docs and more docs would partner with their patients.

Best of luck. Keep taking care of yourself! 🙂

So I agree with the results of the studies you mentioned, I will say that for me after I became a type 2 diabetic that monitoring 3x day for the first 30 days was very useful in helping me change my eating habits since I could see the results of my actions on my blood sugar. I think there may be some value in monitoring early on for eating habits and not overall health; at least for data nerds like myself. But after that I didn’t see the need to monitor daily, more on a spot basis

Excellent episode. I’m from the UK, and when i was diagnosed with type 2, about 10 years ago, daily testing was standard practice. It did always seem rather pointless, as there are too many imponderables to make it an effective means of managing the condition, but i persevered because, like most people, i did what the doctor told me. It was a definite relief, a year or so in, when the guidelines changed and i was told not to bother with daily (or indeed any) self testing. I’m sure that, in the early days, i would have been upset if i’d been told to stop testing myself, but in hindsight, it was always more of a security blanket than a diagnostic tool. Clearly, by exception, there may be a need to do frequent testing, particularly where more “aggressive” medication is prescribed, but for someone like me, on Metformin, it was entirely unnecessary.

This only applies to people who can take just the pills and do not have to take any shots as he stated very early odd and very simplistically one time. Their thumb nail is also very clickbaity

I’m so glad a few people notice that this is only for non dependent on insulin patients. I’m also glad that you actually read some of the articles it does my heart good to see other nerds reading the articles I’ll even read the articles referenced in the article that’s brought up in YouTube videos I often get in fights with people on Facebook going over 8,000 character so I have to make more than one Facebook post over how to read a research paper cuz it seems like all they do is read abstracts

@Katea Jurors Thank you! I’m a pharmacist, so this stuff is my bread and butter! And yea I gave up getting into arguments with people at this point…

For what it’s worth, I’ve got type 2 non-insulin dependent, I was diagnosed about eight months ago, and at this point I mostly test daily. I’ve found out a lot about what raises or lowers my blood sugar. For some reason, I can handle rice congee but not rice. Sweet potatoes are surprisingly bad. Algae supplements seem to help.

And insulin is *very* expensive compared to test strips. I seriously doubt that test strips and lancets are sucking that much money out of the system.

The thing is only maybe 1% of type 2 diabetes patients need insulin, which is not even a good choice of treatment as it causes more hypoglycemia and more weight gain than some alternatives. All of them use test strips. I’m a pharmacist so I see how much money is payed by patients and insurers for either service.
Test strips are generally wasteful as patients don’t even know what to do with the information and GPs use Hb1AC to ajust their medication. The province of Québec in Canada has a government insurance and it just started limiting the coverage to 200 strips per patient per year.

I have serious reservations about these recommendations- patients who are changing regimens, are sick, etc. can’t get extra test strips from their insurance because they are not ‘medically necessary’. We do a poor job with diabetes education for patients who have type 2, and these patients are not always taught the importance of self-foot checks, dilated eye exams, and have less primary care follow-ups and provider administered foot exams. People with type two are (especially when developed young which is more and more the case) are at higher risk of complications which drive up healthcare costs. Daily monitoring (or even better, CGMs) allow for patients to know how food/stress/exercise affects them, and allows for changes that can be managed by the patient. Prevention now, or cleaning up the mess later? I know which I prefer. Let’s teach people with type 2 how to manage their disease so they don’t risk future complications- just like I get to with type 1. Not to mention the mere fact that treating people with type 2 differently that those with type 1 perpetuates stigma and leads to healthcare inequalities for those with type 2.

Completely agree. Diabetes fatigue is real for both type 1 and type 2. And I completely agree with your assessment of the study.

I bought a glucometer out of pocket, and was a tremendous help identifying culprit foods. I did not give a rip about AM or premeal levels–but tested AFTER eating, to SEE what was spiking my glucose. I was able to stop Metformin.

I wish i could talk to you. My metformin was cut by ME to 1,000 mg per day. What ran yours up? Mine was rice and bread.

@T mo Check out Beat Diabetes YT Channel–lots and lots of practical advice. This is my watching channel. I upload videos on Jane’s Journey with a zebra logo. Any kind of high carb food ran mine up…had to ditch bread rice potatoes most legumes most fruit. It’s been worth it!!!

Excellent Video clip! Apologies for the intrusion, I would appreciate your thoughts. Have you ever tried – Patlarny Sugar Outcome Principle (Have a quick look on google cant remember the place now)? It is a great one off guide for reversing diabetes without the headache. Ive heard some amazing things about it and my BF after a lifetime of fighting got amazing success with it.

I beg to differ. Testing blood sugar is important because when you see the results on the glucose meter it helps you to control your food portions and your carb intake. It is a good feedback to see how you are doing with your blood glucose. Now, if someone doesn’t care and just keeps eating the way they want to, then testing is of no benefit at all.

Great Video! Forgive me for the intrusion, I would love your thoughts. Have you heard about – Patlarny Sugar Outcome Principle (probably on Google)? It is a great exclusive guide for reversing diabetes without the hard work. Ive heard some awesome things about it and my cooworker after a lifetime of fighting got excellent results with it.

@Bob Hutton sorry, what exactly do you mean by that it doesn’t matter much what you eat when you’re doing heavy exercise?

@The Other Channel I find my blood sugars are ok (after 2 hours) even if I indulge a bit (like eat a fruit bun). Keeping my blood sugars below 8.0 (from a finger-prick test) 2 hours after a meal is the main thing my Diabetes Educator has me working on.

They actually told you not to do it? I really hope that’s the case for me if I get diagnosed with type 2 in the near future…

I hate needles.

@GregTom2 Only 1%? Really? I’ve read elsewhere that lots of type 2 patients end up using it.

I am new to type 2 diabetes. I am using the Freestyle Libre sensor on my arm to help me figure out what makes my sugar go up and down in real time. It has been so helpful to me so far!

Excellent Video! Forgive me for the intrusion, I am interested in your thoughts. Have you tried – Patlarny Sugar Outcome Principle (do a google search)? It is an awesome one off product for reversing diabetes minus the hard work. Ive heard some extraordinary things about it and my cousin after many years got excellent results with it.

I can understand that testing your blood sugar often throughout the day and not making any necessary adjustments to your diet would render your testing useless. However I’m betting that millions of Americans, myself included, use this information to adjust our eating habits. How else are we going to know if we are keeping our blood glucose in check. I’m willing to bet we are not going to keep ourself healthy by going in to visit our doctor once or twice a year for a few minutes of his time. Besides a lot, if not most doctors have very little training in dietary requirements for diabetes.
Do you want to know what I think is unnecessary and expensive. It’s studies like this that are totally useless.

Kudos for the video content! Excuse me for the intrusion, I would appreciate your thoughts. Have you tried – Loowarn Inconceivable Desire (probably on Google)? It is an awesome exclusive product for getting rid of type 2 diabetes without the normal expense. Ive heard some super things about it and my m8 at very last got excellent success with it.

Congratulations well done!

@tra nguyen thank u ijust wasted 30mins of my life waiting for the solution ,
which is just stupid advertisement

I agree

Totally disagree!! It was only when I started doing my own testing to see how which foods spiked my BG that I was able to drastically lower my A1C from 8.5 to 5.2. The meter keeps .e motivated and healthy.

Do you think CGM meters would be more beneficial to type 2 diabetics

I envy type 2 diabetics, but also find it frustrating how they seem to accept their curable version of the disease. You can do it if you really want it!

No, it was useful especially on the first month diagnosed as a diabetic. It really helps me choose what food to eat that doesn’t spike my blood sugar. It motivates me to continue lifestyle change. And I don’t want to end up being insulin dependent.

EXACTLY. I used testing to gain intimate knowledge about how different foods affected me.

That’s why I’ll listen to doctors, but I’ll also listen to patients who I’ve also learned a lot from because in the end, it’s the patients who have the most to gain or lose.

@Helen B ++

Amen.

This is why I don’t trust “controlled” studies. Real world examples for me are far more telling. And good for you on your improvements! I knocked mine down from 11.2 to 5.4 and when I’m eating right, I’ll test pretty much every other day or so with a consistent diet.

At worst, when I’ve had a rough week (meaning I couldn’t really prepare my own food), my A1C would hover just above 6 which is still not horrible all things considered that I was stuffing myself with fast foods daily (breads, rice, potatoes, etc…).

But I’m a firm believer that testing regularly (especially for those just diagnosed) is a great tool in one learning to monitor what diet is best for them because diets are a very personal thing. Not every diet works for every diabetic.

I started paying out of my pocket for extra strips I checked three to four times a day I’ve got my A1C down to 5.8 smallest dose of glipizide

I agree but I think if you can control what you eat you can also control your blood sugar levels. And that theres no need to test glucose levels. Im diabetic and im still using glucometer just to be sure.

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