Self-monitoring of Blood Glucose for Type 2 Diabetes
One of the tasks that we have to do as people with diabetes is to monitor our blood glucose with a home glucose monitor (glucometer). This is called self-monitoring of blood glucose, or SMBG. Every day we stick our fingers with a needle, draw a drop of blood and let the meter tell us where our blood glucose sits (give or take 20%). People who use insulin to attempt to control their diabetes will repeat this up to 10 times per day, but those of us who don’t use insulin may only be checking blood glucose levels once per day or every few days. Is the latter the best method for reining in high blood sugars? This is a highly controversial subject, even among medical professionals.
I recently read an article by the Medical Journal of Australia that discusses this subject and how T2Ds can most wisely use the test strips they are allowed. Although this article is specific to Australia, it is relevant to those of us in the US as well. It is thought that the “clinical benefit (of using of SMBG) for people with type 2 diabetes who are not using insulin is, and we believe remains, a matter of debate.” My initial response to that is, how could it NOT be beneficial? In what universe is keeping track of your health not beneficial? The reality is that many people with type 2 are never given education on how to use their meter to make decisions about the food they eat or the exercise they do. They just don’t know any better, and therefore are not using that information to make changes to their plan.
Many people with type 2 diabetes are only allowed a minimal amount of test strips per month through their insurance. This is the reason that I have never used my insurance “benefit” for test strips in all the 10 years I’ve been dealing with diabetes. I bought a glucometer with inexpensive test strips and I buy whatever I feel that I need. Not everyone can afford that option or even realize that it is an option! I’ve always been an advocate of using your glucose monitor to help you make decisions about what you should/can eat. You have no way of knowing what a food does to your blood glucose unless you check, right? So how is one glucose check per day/week going to help you? It won’t.
The reality is that lots of people with type 2 diabetes can’t afford, or are not allowed, adequate test strips to do a good job of monitoring how foods affect their blood glucose. The article mentioned above had an idea that I had never heard of before: Structured SMBG. A study was conducted where in “structured SMBG was defined as seven checks per day over 3 consecutive days in the week before their consultation with a doctor about their diabetes.” 21 test strips. They also kept track of meals and meal size etc to give the data some reference. In other words, using their test strips in a way that would allow education and understanding of how foods and exercise interact with blood glucose. This is an idea I can get behind. The study went on to say that having a health care provider who is trained in how to interpret blood glucose data and help the patient understand the results is key. Patients in the study indicated that they felt less stress and more satisfaction with this approach as well as lowered HbA1cs.
While I will always advocate for better, regular blood glucose monitoring as a way to improve health of people with type 2 diabetes, I feel that this Structured SMBG approach is a great idea for those who have limited access to test strips.
Do you live with any sleep disorders (eg. insomnia, sleep apnea, RLS) in addition to your diabetes?