Honolulu,
Diabetes is, above all else, a disease that comes with a lot of worries. Between looking after blood-glucose levels with testing, insulin and medication there is also the long term worry of what it may mean for your long-term health. The general, statistical opinion is that it can take up to 10 years off your life. I happen to disagree with that, I think that long-term prospects are down to the individual and their ability to deal with and manage their condition (for example, I plan to live forever!)
But these worries and concerns can easily lead obsessing over your diabetes and spending far too much time dealing with it. Professionally, one of the most common issues I come across is people testing their blood-sugar too often. You’ll ask: “how is regular testing a bad thing?”. The answer is that regular testing is fine, as long as it doesn’t give you false information and lead to you making bad decisions regarding medication.
For type 1 diabetes, most people use a “basal/bolus” system that combines long & short acting insulins to mimic the actions of a normal pancreas. The long acting insulin acts as a background dose and the short acting is used to deal with food. The problems start when people forget that all short acting insulin has a fairly long “active” period (for example, Novorapid has an action time of 4.5-5 hours). Say before lunch you test your levels and they are 6.8 mmol, you take a shot of novorapid and eat. Then out of curiosity/worry/”because a nurse told me to” you check again 2 hours later and the level is now 9.9 mmol. You get worried that it’s now too high and immediately take another small injection (of maybe 1-2 units) to correct the “high”.
Sorry guys, but this is wrong and it will cause more problems than it solves!
After 2 hours the insulin is only halfway through its action period, digestion has peaked and you are not allowing the insulin time to complete its job. What should happen is that the 9.9 mmol “high” will come down over the next hour or two and by dinnertime you should be close to the same level you had at lunchtime (this is assuming you are using the correct insulin ratios for food and your background doses are correct). However the correction dose you gave after 2 hours is now in the mix and you may find that you get do dinnertime on the edge of a hypo. You’ll then attempt to correct that less insulin at dinner, which will run into the still-active 2 unit correction dose and the cycle will become more and more vicious as you try to battle blood-sugar levels that start to see-saw from high to low. “Chasing your tail” would be the best way to describe it!
The other reason not to test too often is because psychologically it is not good for your state of mind. This is true for type 1 and 2 diabetes as well. People with type 2 usually don’t usually need to test as often but the same issues can arise. you spend all day testing, stressing, feeling good because its “in target” or feeling worried that it’s high you are going to fry your head! It is the very definition of diabetes running (and ruining!) your life.
But there is a better way!
1) First you need to set a structure for testing. Test only at these times:
- Before breakfast (or when you get up if you don’t want to eat breakfast)
- Before meals / snacks
- Before bed
- Before and after exercise
The only exemptions to this are to confirm a hypo, before driving, if you are ill, if you are in DKA/H.O.N.K or if you are pregnant (pregnancy target levels need post meal testing). In these situations it actually makes sense to keep a closer eye on blood-glucose fluctuations.
2) Stop post meal testing completely. It only gives you false information that will cause more problems and has no value for achieving long term, stable control.
Post meal testing is still recommended by some doctors and nurses but thankfully such advice is gradually becoming less common. If you’re care team suggest doing it then explain your reasons for not doing so, the facts speak for themselves and you are the one who has the final say on your diabetes care.
The best way I can put this across is to tell you something I decided on some time ago. I took the point of view that I only had diabetes when it came I was getting up in the morning, when I was about to eat, or just before I went to bed. These snapshots of time allow me to deal with diabetes at that moment alone, after that I can forget about it for a few hours and get on with the much more important job of enjoying my day. Any problems can be dealt with at the next logically scheduled test. Yes there could be a hypo here and there, but 9 times out of 10 this works for me.
There is such a thing as too much information, keeping this in mind lets me decide which data is useful and which I’m better off not knowing at all. No more worrying about “what’s my blood-sugar doing?!”, no acting based on fear & emotion. Just logic and knowledge. This structure works for me and it will for you too.
Enjoy your health (and put down the glucometer!!)
Chris | YD
Blood Glucose Testing: How Much Is Too Much?
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