Why test your blood sugar? Amy T has a terrific guest post by Dr. Richard Jackson up at Diabetes Mine this morning. CLICK HERE
He specifically discusses some studies done with type 2 patients and the effect of self monitoring of blood glucose (SMBG). The goal of SMBG makes good sense, that “SMBG results can show you the effects of your physical activity and exercise, provide you with information about the glucose impact of meals, warn you if your glucose is too low, and provide an overall idea of how well your glucose is controlled.” But the studies didn’t support that, at least directly, and an indirect conclusion was that SMBG can make you feel bad.
The third lesson from these two thorough studies stems from the finding that patients who used SMBG were slightly but significantly more likely to report symptoms of anxiety and depression. These feelings didn’t occur in every patient, obviously, but the increase is worrisome. The educators and physicians involved in these studies were well-trained, experienced, and committed to helping their patients with diabetes. Yet somehow many patients ended up feeling bad about their SMBG results. The lesson here was that even when care providers mean well, SMBG can produce negative feelings.
Surely this is exactly why many of us give up on monitoring. If we are not on insulin, there isn’t much we can do about high blood sugars (in the short term) and testing can feel like constant flogging for being “bad.” The problem is that it really is useful information for us. It tells us how different foods and exercise and illness affect our blood sugars and that’s important to know. I wonder, doing the same studies with insulin dependent folks - wouldn’t it be likely that they experience the same sense of failure when the numbers are “bad”? Wouldn’t they want to hide from bad numbers and pretend - just like those of us who aren’t insulin dependent? The difference is, to me, that both highs and lows have more significance. While I may experience a low, someone taking regular (as opposed to long acting) insulin is more likely to have a dangerous low and highs can be corrected. The SMBG has, therefore, a more immediate use and effect than for most type 2s. But the immediate use of SMBG results is only part of the puzzle. Both type 1s and type 2s need to use the SMBG results to understand trends and help guide changes in overall treatment.
Most importantly, if your A1C is above target, use your SMBG results to look for solutions; Is there a time of day when you are always higher? Are weekdays worse than weekends? What happens after meals? Take this information to your health care provider, so that together you can decide on some CHANGE that will move your A1C back toward target.
Thanks to Amy T for the interesting article. What do you think of what Dr. Jackson has to say? Why do you test or not test your blood sugar?