This was a very thought-provoking article. I have been helped for years by reading your articles (first on your website, now on HC). If it weren't for you and all of your comments about testing your BGLs after eating certain foods and making adjustments, I might not know what I do. Although I ate what I thought was a "healthy" diet before, I included whole grains and some high-carb fruits and my blood sugar was very high, even with exercise.
Once I started testing and adjusting, I found that eating low carb made a dramatic difference and I felt much better. I have been taking Byetta and my doctor is considering taking me off of it, because my AIC has been completely within the normal range for over two years. Thanks for everything you do, David, it really has helped!
OK, maybe the majority of people who measure their BGs are just too lazy to do anything about improving those. However for a SIGNIFICANT minory it will make a big difference. They will in fact take action and improve their BG level- once they know it is unacceptable. So to say that measuring your BGs does not make a difference is incorrect.
JG
Thanks David for your article, always enjoying reading/learning new things each month. As far as testing goes it is so important to test, "test don't guess" is dlife's motto,which I agree. First it is important to count your carbs before you eat and if you are on insulin [which I am] inject according to what formula your doctor has given you. Then wait at least one hour before doing any time of exercise because that is when your blood glucose/and insulin are at their peak. Then do some type of exercise--cleaning, walking, weights, etc., do "something" do not sit. Sitting is a diabetices worse enemy, it gives the blood glucose time to "sit" and go high. This process works great for me ! This disease is "ours" to control and we must decide to make a choice to keep our bodies healthy AND no it is not easy but it is something we can handle.
I too, am a type II diabetic and use my bg monitor religiously. It is even a good tool for overweight people without diabetes. However; it is like you say, IF you do an action after testing.
If my bg is too high, I drink some water and do some activity. If the symptoms are severe (like dizziness), then I sit in my recliner and do leg lifts to get the blood to moving. If the symptoms are mild or not at all, then I will go for a walk.
I always try to add cinnamon to every meal to help keep things under control. Unlike other diabetics, I also battle gout, so it is a vegan diet for me, but cinnamon is a wonderful control. So is ginger.
If I feel hungry, I will check my bg. If it is too low, then I will eat, if it is too high, then I will have a soy protein shake. It stops the feelings of hunger, and is low in carbs.
If I feel full, I check my blood. I figure if the number is high, then I have overeaten, if too low, drink some water because the food I ate is not digesting. Doing this has helped me to lose 6 lbs per year without "going on a diet".
I hope this helps. Remember celery and artichokes help with high blood pressure and kidney problems. So do kidney beans and walnuts. Eat the rainbow and you cannot go wrong, skip the whites.
Gerry
Years ago I and a friend were diagnosed with type 2 diabetes at the same time. We were the same age, in our late fifties. I started testing right away, changed my diet and went on insulin within the year. My friend didn't do any of those things and today he is dead from complication from diabetes.
On a bike ride last Sunday which our local pharmacist was on he stated he was at a meeting not long ago with govt officials and insurance companies where the consensus was the cost benefit wasn't worth it to pay for strips so no more insurance coverage may be the result.
I like you, David, tell people who have diabetes that they have to be their own advocate. I put myself on insulin and insisted that I get a C-Peptide test against the objections of my endocrinologist only to find out that when I finally got one that I was indeed a type 1.
I sometimes wonder what would have happened had I taken the route my friend took.
David comes through with the goods. Surges in blood sugar that have no relationship to what I've consumed in the past four hours and I'm not in some kind of pain or sick or sommat? are annoying at best. As a Buddhist it's not like I have wild swings of emotion (up or down) so it's not like I was in a blind rage and that precipitated the high sugar.
Thanks David (Namaste)
jccampb
I have been diagnosed as Type II Diabetic for 2 years and 2 months. I understand the results of the study on blood testing for non-insulin treated diabetics but I am one of those that finds blood testing helpful to controlling my diabetes. These 2 years have been a learning process of what foods are tolerable and what I need to avoid. I am only 51 and hope to have many more quality years of life. I realize that the better I can control my numbers with diet, exercise and less medicine, the better off I will hopefully be in the future. When my meter numbers are not in the range I have set for myself I evaluate my actions and make necessary changes. Many times I have had to drink extra water and exercise to bring my number down but at least I am able to test my blood to make these decisions. I have been shocked by my number after some meals because I felt so normal only to find my number way out of range.
One of my family members (female) has taken one diabetic nutrition class a couple of decades ago when first diagnosed about 25 years ago at age 67. She doesn't read books, doesn't watch medical shows, doesn't eat a diabetic diet, never eaten low-fat, low-carb, etc.
She has never been a drinker, smoker or exercised regularly. She has lost about 45lbs over the years so her weight is within normal range and the only other medication she takes a high blood pressure med that was started a couple of years ago.
What she does do is to test before and after each meal and faithfully keep a journal. She's has learned over the years what foods and quantities make her glucose and weight increase and she applies that information daily. At first when her glucose was too high, she would "walk it off". As she got better control, she did less walking (hurt her knee about 15 years ago).
She's still sharp and gets around pretty well overall. She's still going strong and very slowly declining (hearing mostly).
I'm going to ask her what her A1C is just for the record.
Should we all be so fortunate.
David, David, shame on you.
Although it takes some serious effort to learn how to use a blood glucose meter properly, i.e. using it to learn how one's sugar levels vary during the day, and also vary depending on what you eat, how much you eat, and when you eat, that effort is very well spent.
specifically, without understanding and carefully monitoring one's blood glocuse level, one is very much working in the dark to learn how to live with diabetes type 2. with such careful testing and checking and correlating, a person can make enormous changes in their a1c results, and also avoid adapting a diet that is unnecessarily restrictive and "no fun".
i was able to drop my a1c from 9.4 to 6.5 within a few months. and i'm still working at getting it lower than 6.5. without a glucose meter and frequent testing during these months i'd be living like a monk, unnecessarily. and i might even be doing wrong things to manage the diabetes.
your article gives the impression that self-testing with a glucose meter is a waste of time and money. that is 180 degrees away from the truth. yeah, you gotta be careful and diligent, but that's true of life in general.
why did you write such a negative article about such an important tool that diabetic type 2's can use? not nice.... and if your negative article contributes to the stupid trend of insurance companies to not cover the cost of test strips, than double not nice.... i thought you were a good guy!
gary/
No test will change anything. It is what we do with the results. Numbers are just that. BUT taking those numbers as a guideline and making adjustmrnts in diet and lifestyle do make the difference. Ask yopurself this. Are we treating the numbers on a sheet of paper or on a meter or are we treating the person?
thanks pj, you are very right.
after making my post i DID re-read the article,
and felt a little dumb for having written my post
the way i did.
but...here's the rub...
mainly, i don't think david came down nearly hard
enough on the Cochrane report, and the great
minds that prepared it.
(i'm particularly sensitive to this whole issue
since my current health care insurer suddenly
decided that ONLY type 1 diabetics, taking
insulin, should be covered for blood glucose test
strips. suddenly, no coverage for what is a
somewhat pricey item. i'm affected by this
everytime i now go to the pharmacy and have to
pay full price for the strips.
but i pay the price for the strips, because i
feel they are a very important part of my
personal healthcare regimen. and i'm very
annoyed that the powers that be are
misunderstanding just how important is
observation and management of one's blood sugar
levels, and how much of a learning curve there
really is in understanding how one's internal
systems work in response to food eaten,
quantities eaten, and time of eating.
tryng to manage diabetes type 2 without reasonably
frequent testing is like driving a car without a
spedometer, only even harder to do than that.)
so i guess i was expecting david to come down
harder on the Cochrane report, and the people who
wrote it. i wouldn't be surprised if, in fact,
cochrane was influenced by drug companies who
just prefer the sledgehammer approach of shoving
drugs down our throats to solve the problem of
diabetes 2, rather than helping us to see the
light through better education and training about
intelligent blood glucose management through
observation, diet control, and exercise.
that's the gauntlet i was hoping david would
throw down. but, again, you are right. on re-
reading the article i clearly see that david DOES
agree with me. so *I* will be the one to throw
down the gauntlet.
i am saying that the Cochrane
report is either highly-biased (influenced by
drug companies), or highly misinformed. and
that's unfortunate. potentially it's a big step
backward for us type 2 diabetics who need all the
real support they can get.
Gary/
Well said, Gary. I completely agree with you. I am only "pre-diabetic" but learned so much by using BG test strips to see the effect of different foods on my particular, peculiar body. After a year or so of incessant testing and reading and changing my diet drastically, benefitting from David's advice, I had dramatically improved the way I felt and reversed many medical symptoms I had struggled with for several years. Nevertheless, I decided to go to an endocronologist looking for help on some of the finer, still frustrating issues. She basically said that I wasn't pre-diabetic [because I had returned to a normal HA1C] and dismissed me saying that anyone would feel better if they ate a good mediterranean diet. My guess is that she is among the many endos who don't even bother giving dietary advice as an alternative to drug therapy on the theory that people won't be able to stay on the diet anyway, so why bother? That kind of thinking makes my blood boil! Give me the information and let me decide, please.
I also agree with you that it is ridiculous that some medical insurance won't cover the cost of testing strips even for diagnosed Type 2 diabetics. Really, would anyone want to test themselves for fun -- or any reason other than important health concerns? It's not cosmetic surgery, for pity sakes, nor is it less important than many covered expenses such as viagra or sleeping pills.
I don't understand why the strips are so expensive either. Surely they can be produced at sufficient profit for less than a dollar a strip. I'm guessing that the cost is so high because insurance used to pay for them. Now that it does not, people like you and me are facing a real financial burden. I used to be able to find strips on-line for significantly less, but that source has disappeared. At this stage of my disease I don't need to test as often as I used to, but still without testing it is SO easy to backslide -- and impossible to know the effect of new foods or combinations of foods on this mind-numbingly complex biochemical mystery that is my body.
PJ
Maybe the reason the insurance company does not pay for your test strips is that you are not diagnosed as a diabetic, it you were they would have to pay for your strips. I agree that the test strips are much too expensive, but the strips are a very powerful tool that tells us a lot, but something tells me they could make them at a cheaper price, afterall we will ALWAYS need them so the demand will always be there. As far as your endo tell you that you were not pre-diabetic, lets face it, if your blood glucose numbers are up, something is "wrong" with your body and it needs to be checked out. It is good to see that you are taking care of yourself, keep up the good work.
Hi all,
As a 20 year plus diabetic 2 with current A1c 5.2% without any meds, neither complication, no more leg pains. I would respectfully disagree with that article.
Daily blood sugar testings is arguably the most useful tool to combat diabetes.
Ask yourself this question: without glucose testing how would you find out which food is harmful to you? so that you would avoid that food the next meal?
I had leg pains aka nerve pains as most of long time diabetic, then I found out about dr. Richard Beirstein rule:(6,12,12), described in his book:Diabetes Solutions.
Part of my succesful stopping my nerve pains is keeping dr.Beirnstein rule: (6,12,12). Everyday, I monitor my pp ONE hour, not TWO, after meal.
I am enjoying my life as much as any non diabetic.
A useful article. Panic reading or too much worrying is not going to reduce the levels.
As you have advised, one has to find out what works for one, and that can bedone by the individual. A good udnerstanding of the subject is a must in the case of glucose levels.
In my case, low carb diet did help me to reduce the fasting blood sugar in a matter of few days.
The post meal levles are fluctauating , and I am trying to find out the right foods , all the time.
Overall the low carb diet helped a lot.
I test my blood glucose first thing every morning. I don't have much Dawn Effect nowadays. I do know what to do if I'm off my own target of 4.0mmol/l [72mg/dl] to 4.5mmol/l [81mg/dl]. If I'm outside that range I avoid carbs pretty much altogether until I get back down, which could be up to 2 days. I low carb the rest of the time. I do find 1 test per day sufficient, because I respond to that morning reading. I keep trying to get other diabetics to do something like this, but the usual testing regime for T2 in England is 1 test per week. I DON'T think it's enough and if that is the testing regime that doesn't improve outcomes, I'm NOT SURPRISED.
No only are English diabetics not funded for daily testing, but they are usually told to follow a low fat/high carb diet. Diabetes care in England is often based on some BAD SCIENCE or no science at all. the most imporant consideration is money saving in the short term. Plus the use of multiple pharmaceuticles.
Very useful post. I like the idea of taking a walk after a meal if 2 hour glucose is high. It is quite logical and works.
In diabetes, the patient is in charge of looking after himself. The diabetes team will guide you. In type 2 diabetics who are not on insulin as well, frequent glucose testing is not necessary.
Following results would be ok
Fasing glucose 4 mmols - 6 mmols (72 - 108 mg)
Random glucose 4 mmols - 8 mmols (72 - 144 mg)
HbA1c <7%
If results are in range, checking 2 to 3 times per week at variable times is satisfactory. Keep a diary so that the diabetes team can see them.
Random glucose should normally be checked 2 hours after meal.
These are some suggestions only. Always follow the advice of your diabetes team. Read Diabetes in brief
I'm another Englander and I don't follow my doctor's advice - "Plenty of complex carbs like potato, rice, pasta".
I low carb and aim for targets similar to yours. Fasting glucoce <5.5mmol/l, post prandial <7.5 at one hour and <6.5 at two hours.
The quality of advice in England is poor (in my experience) and the expectation of progression of type 2 and complications are seen as essentially guaranteed.
I'm not sure that's correct, or even a problem. Ketones in the body just indicate that you are burning fat and that's generally a good thing, especiallky if overweight or on a realtively high fat diet (becuase of low carbing).
I probably eat around 30-50g of carb per day. If I go over 20g in one meal I generally see a spike in BG. Almost all of my carbs are from fresh vegetables and beans, with the rare slice of wholemeal bread or small portion of fruit. Though my wife has recently found some frozen chocolate-dipped strawberries that are 2.5g per strawberry and eating two doesn't affect my BG - nice treat :)
Less than 100 gm carbohydrate per day will increase the amount of ketone bodies produced - 'starvation ketosis'. Safe limit of ketones in blood are not exactly known. In diabetes, both carbohydrate and fat metabolism are abnormal. Too much blood sugar causes glucotoxicity and too much fat breakdown products cause lipotoxicity which one should try to avoid. Diabetics cannot handle these as efficiently as a normal person can do. Effect of gluco and lipotoxicity are mainly to affect lining of blood vessels - atherosclerosis. Atherosclerosis is a normal ageing process which is hastened in diabetes, high cholesterol, high blood pressure, smoking etc. Symptoms of accelerated atherosclerosis takes time to develop.
These are my ideaas and thoughts. These are information only. Please follow the advice of your diabetes team. Have a look at Health-ideaas and tell me what you think.
Research like this scares me. I haven't always been perfect but I try to test my blood glucose 5 times per day. How else am I going to know what's going on? I don't trust food labels and often find myself wondering why I am having trouble maintaining reasonable blood sugars after meals. Through testing I am able to identify the culprit. So for some of us, regular testing is exceptionally valuable.
That said, I still have struggled to get my A1Cs below the high 5s. Before you say "wow that's good" - I am on an exceptionally low carb diet and am very reactive to any carbs. We all know that exercise is exceptionally important. Today I had my 6 month visit with my doctor and she used the "remission" word. My A1C was 5.2. The last 6 months as far as diet goes haven't been great. So what's the difference? Over the last few weeks I have been getting exercise after every meal I can, even if only a modest amount. I don't care if I go walk up and down the stairs at work a few times. Bicycling a couple easy miles works the best for me. I'm taking the top off of the blood sugar surge after meals and sometimes I find myself fending off hypoglycemia which, as long as I know it, is a pleasant new experience compared to high blood glucose.
I'm guessing my next A1C will be in the high 4s. I'm also looking forward to adding a few healthy foods that have a few more carbs (more fruits) but being able to keep my blood sugar in check. So exercise is important for general health - the timing of exercise is even more valuable for blood sugar control.
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Nicely stated. I've been diagnosed Type 2 for over 10 years now and I measure off and on. When I do, it has been pretty extensively. Being an engineer, I was always measuring to see "what's going on" when I eat. I always stop measuring because I don't really DO anything as a result. I am thinking I may start again, at least for some period of time, to see what my peak reading is now, say 74 minutes after starting meals. That might help motivate me to get off my duff; I've given up exercising in the last year...not a good thing. So, thanks, David.