# This will ruffle some feathers, but explains a lot



## Vicsetter (Apr 19, 2016)

*Advising patients who self-monitor their blood glucose*
Dr Tina Farid, a GP with an interest in diabetes, discusses which patients require self-monitoring and those who do not


This article in Pulse discusses the use of blood test monitoring for t1s and t2s:
http://www.pulsetoday.co.uk/clinica...-monitor-their-blood-glucose/20031470.article

It repeats the nice guidelines and concludes that great cost savings can be made by standardizing on a particular meter and refusing strips to T2s who are not on hypo inducing drugs.

You will need to register to see the articles, but it is free.


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## Northerner (Apr 19, 2016)

I was going to post this yesterday but when I saw the 'premium content' thing I thought it was a paid-for registration - I usually get straight in on my free registration without needing to sign in! 

So annoying! The entire emphasis is on hypos. There are some points that really give the game away:







None of those 'disadvantages' come anywhere close to comparing with the advantages - rarely painful; owning scissors could be dangerous, or knives, or pins...; may cause anxiety NOT KNOWING; people can be taught to interpret results - it's not that difficult; b****cks about calibration!; test strips are MUCH cheaper than hospital admissions and surgery. What utter nonsense!  Whatever happened to treating the patient on an individual basis? I really hate this blanket approach to people - we're not cakes, we don't all come out OK if we follow the same recipe, we need to adjust according to taste!  Four out of those six advantages apply to everyone, regardless of medication!!


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## Sally71 (Apr 19, 2016)

The final disadvantage is the real one - cost.  All the rest are rubbish!
May cause pain / anxiety in some patients - yes that might be so for SOME patients; for the vast majority, probably not.
Disposal of needles can be dangerous - well yes, but how do they think people who need daily injections just to stay alive manage?!  What's a sharps bin for then!  Just because you aren't on insulin doesn't mean that you don't have the brains to think about these things...
May not know how to interpret results if not educated - well of course they bloody won't, so educate them then, just like you have to educate all T1s!  Isn't that what doctors and dsn's are supposed to be for?! You could do classes for several people at a time to save time and money.
And most test machines don't need calibrating any more, and if they do it only takes seconds.
What a load of rubbish!  You were right about it ruffling feathers


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## Robin (Apr 19, 2016)

My lancet drum doesn't even have any sharp bits protruding.


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## Diabeticliberty (Apr 19, 2016)

I have long held the belief that we are in the rather unfortunate position of having some doctors who appear to feel that the NHS would run perfectly smoothly providing they didn't have to deal with a particular unpleasant aspect of their job. Now what do you call them? Hang on it escapes me for the moment........erm.......now I have it - PATIENTS. While the very cheek of them plonking themselves in front of us with their whingeing, whining illnesses and coughing and spluttering their dirty germs all over us. Why the very thought of it makes me almost sick. 

I also believe that the time is not too far off when the NHS will no longer fund blood testing for diabetics of any type and expect us all to self fund. I sincerely hope that I am wrong but I sincerely believe that I am right. 

If you go through the list of advantages and disadvantages listed above there is one that screams out loud for all the world to hear - EMPOWERS PATIENTS TO SELF MANAGE THEIR CHRONIC DISEASE. You could build a list of disadvantages that would run end to end to the moon and back and even added together all of them cannot stand up to the big bold advantage I have highlighted.


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## Riri (Apr 19, 2016)

Just pick to pick up on 1 point (I could go through them all), do they not understand that for most of us if we don't have the means to check what our blood sugars are doing, the heightened anxiety from that causes untold problems including stress with it's long term damaging effects. The long term damaging effects of running high blood sugars can cause a myriad of serious complications. Nonsense indeed.


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## trophywench (Apr 19, 2016)

I agree with all of this thread so far, except the content of Madame Guillotine's message.

There are disadvantages to most things - IF YOU ARE DETERMINED TO FIND THEM.


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## SlowRunner (Apr 19, 2016)

This is just my opinion but if a person with T2 is switched on enough to want to test their levels and attempt to self manage that should be encouraged, not restricted! I only know of 2 people in my family with T2 & neither of them are at all interested.

My uncle has had it for years, suffers with high blood pressure, leg ulcers and is nearly blind. He has been a huge drain on NHS funds for many years due to the tablets he's on & the complications he has. He has never shown the slightest bit of interest in helping himself (other than to sweets & cakes!!).

My mum was diagnosed only recently and is only just in the diabetic range so is currently managing with diet & exercise. Unfortunately she has taken the stance that the nurse at her practice knows what she is talking about when she said there was no need for her to self monitor, & has also only been warned about high sugar foods so is still quite happily munching bread, rice, pasta, bananas, etc. and has no idea what any of this is doing to her. She doesn't want to test either & says she feels sorry for me having to test all the time!

So I would have thought that a T2 with an interest in actually looking after their own health would be a breath of fresh air!


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## pottersusan (Apr 19, 2016)

It makes me want to SCREAM.



Northerner said:


> we're not cakes, we don't all come out OK if we follow the same recipe, we need to adjust according to taste! !



You obviously haven't eaten my cakes... same recipe - different results. my excuse is I rarely bake a cake these days.


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## Sally71 (Apr 19, 2016)

Loving all your replies 

And of course I forgot to add onto my earlier post that the cost of strips is a bit of a non-issue when you compare it with the cost of dealing with (largely avoidable) diabetic complications; unfortunately the people who hold the purse strings can't see beyond the next audit 
In fact I reckon they've made all these disadvantages up just to try to hide the fact that they are only bothered about short term financial savings.

Think I'll go and bang my head against a wall now, reading all this sort of thing makes me really annoyed!


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## Vicsetter (Apr 19, 2016)

Told you!!!
I might add that there is no suggestion that an hba1c is taken every 3 months because that is all it measures!


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## everydayupsanddowns (Apr 19, 2016)

Here's something interesting I found out this year... The majority of the cases (and attendant expenditure) for Severe Hypos does not come from errant adolescent T1s, or struggling parents with very young and unpredictable T1 children... no. The vast majority are elderly people living with T2 who are on insulin or oral hypoglycaemics.

And yet... by not allowing people to measure and understand their bodies and how they react to carbs with test strips there are a host of people who are propelled mercillessly through the GP ticksheet onto more and more meds and ultimately insulin. We have several members here who have been able to reduce or avoid the need for such meds - and others who (because they DID self monitor) were much better prepared to add medication in a more personalised way.

I completely agree with Northie's destruction of the nonsense of that table, and the people who wrote that should take a long hard look at this study. Unstructured occasional BG tests (as are most often advised) are useless. People need to be given test-review-adjust education and treated as intelligent individuals.

https://www.mja.com.au/journal/2015...sely-when-it-comes-monitoring-type-2-diabetes

Bah!!


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## Mark Parrott (Apr 19, 2016)

Advantages of testing: Everything
Disadvantages of testing: None


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## Northerner (Apr 19, 2016)

Mark Parrott said:


> Advantages of testing: Everything
> Disadvantages of testing: None


And if ever proof were needed Mark, you're it!


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## Vicsetter (Apr 19, 2016)

Referred to in that Pulse article is this Oxford based study: http://www.bmj.com/content/335/7611/132
A further reference is to another article (http://www.idf.org/webdata/docs/SMBG_EN2.pdf) from the International Diabetes Federation (never heard of them!). which concludes:





> SMBG (Self Monitoring of Blood Glucose) should be used only when individuals with diabetes (and/or their care-givers) and/or their healthcare providers have the knowledge, skills and willingness to incorporate SMBG monitoring and therapy adjustment into their
> diabetes care plan in order to attain agreed treatment goals.


Which about sums it up, SBMG is no use if your GP or you are a numpty!!


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## LeeGee (Apr 19, 2016)

One thing I've often wondered, is why the NHS doesn't use it's massive buying power to procure test strips that we can then buy at cost price. They'd cost around a tenth of the price on the high street and we wouldn't need to ask for freebies.


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## Northerner (Apr 19, 2016)

LeeGee said:


> One thing I've often wondered, is why the NHS doesn't use it's massive buying power to procure test strips that we can then buy at cost price. They'd cost around a tenth of the price on the high street and we wouldn't need to ask for freebies.


The NHS do have deal with suppliers, I think most of the major brands have been negotiated down to around £15 for 50 strips. Of course, now they are doing exclusive deals with cheap, lesser-known manufacturers so getting a better deal on them. It's all a bit of a red herring though, as the money spent on treatment for preventable complications far exceeds the cost of strips (they spend around 50 times as much )


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## LeeGee (Apr 19, 2016)

I think they can do better than that. I had two NHS hearing aids a few months ago. I asked the guy how much they would have been private. He said £2500. I said I felt really guilty costing the NHS that much. He said not to worry as the NHS gets them for £70. Mind you he did say they purchased them at a million units per order. That's buying power for you.


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## everydayupsanddowns (Apr 19, 2016)

Vicsetter said:


> Referred to in that Pulse article is this Oxford based study: http://www.bmj.com/content/335/7611/132
> A further reference is to another article (http://www.idf.org/webdata/docs/SMBG_EN2.pdf) from the International Diabetes Federation (never heard of them!). which concludes:
> Which about sums it up, SBMG is no use if your GP or you are a numpty!!



I have heard Andrew Farmer (author of that first paper) talk and he has looked at T2 testing more than once, but seems to have decided that it doesn't work. He did concede in a question that it is an option for 'some individuals' but the way he has constructed his studies has repeatedly shown that SMBG doesn't work. I've not looked at this one in detail, but often there is mention of 'adherence' to a supplied dietary plan, rather than using results to formulate an individualised low-spike menu based on how a person responds to food.


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## KookyCat (Apr 19, 2016)

Ahem, now I might be being a total dullard but are we saying that on the basis of that cost benefit analysis they conclude people with type 2 shouldn't test?  

So, 
1.  Teach them how to do it properly and it won't hurt
2.  Give them a sharps bin
3.  Tell them what to do about the results so anxiety is lessened
4.  As above
5.  Tosh, but if I must dignify it with an answer, then calibrate the meter, three seconds job done
6.  Tot up and tell us the cost of complications of diabetes, think for 2 seconds....there it is.

Right so that's the disadvantages sorted, the advantages look good, so let's go, get everyone the test strips and jobs a good un.  Ooh and look I didn't need 7 years of medical school to come up with those gems.  

Incandescent with rage is becoming my natural home


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## khskel (Apr 19, 2016)

I can't add anything that's printable except to agree with Northie that people like Mark P are living proof that testing is a positive boon for motivated type 2s. Case studies like his should be circulated to every GP/DSN


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## trophywench (Apr 19, 2016)

Yeah but who would train all these T2 diabetics who like the rellie referred to on Page 1, aren't in the slightest interested in helping themselves, since 'That's YOUR job'.

Talk to a podiatrist - they see plenty of people who haven't even washed their feet since the old queen died, let alone cut their toenails or generally paid them the slightest attention - because when they have a prob - that's the podiatrists job and I've paid my NI contributions and Income Tax so I'm entitled.


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## Superheavy (Apr 19, 2016)

Hate to say it, but even as someone who is new to the whole diabetic thing, while there are some aspects of diabetic education that don't seem to be up to date (you must eat more carbs...) in terms of the result I see on my reader, being able to test myself and see which foods are causing the spikes, and then adjusting my diet accordingly, is vital to the changes I've seen. Much like Mark, without the test, I couldn't have seen how my levels go from a HBA1C with an average 11.2, down to results that sit in the 4-6 range apart from the occasional jump into the 7s. I dread to think how much the gliclazide they wanted me to take would have cost over several years, let alone the further medication costs for 3rd and 4th tier treatments, but the cost of the testing strips and device, which were prescribed, must be so much less than all the pills.


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## Sally71 (Apr 20, 2016)

Ah Well TW, there will always be some people who prefer to just take a pill and then stick their head in the sand and hope it will all go away.  I'm sure there must be many more though who would much rather take a more active interest in the state of their health, if only they could be shown how!


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## KookyCat (Apr 20, 2016)

There are plenty of T1s who don't help themselves either but they manage not to lump all of us together and assume we're all incapable (just), there will always be folk who want to close their eyes tight and shut out the reality, it's just the way it is.   There will also be those who go against the tide and self fund and test.  It's the middle ground, like the lady I work with, who are given the impression it's nothing serious, and they don't need to test and just need to follow doctors orders.  If her doctor told her to test she would, but because she's told she doesn't need to she won't.  Her A1C is way too high, and always has been, they're talking about insulin now because she's showing signs of neuropathy and retinopathy.  Now the doctor's tone has changed, diabetes is a progressive condition, inevitable, insulin is the only answer, the neuropathy is progressive etc etc and she's absolutely petrified and shocked, because the there there just do as you're told approach has led to this.  She's not a stupid woman, she's very bright in fact, but inordinately compliant.  If she'd been shown another way she would have done it.  Her lunch the other day was a tub of rice with veggies and boiled chicken, followed by two small satsuma things and a banana, just like the dietician ordered....when I asked if she enjoyed it she said no, I hate rice and fruit I'd much rather have a chicken Caesar salad and Greek yoghurt with almonds, but I'm not allowed.  I nearly fell off my chair.  The salad and yoghurt would be a much better choice.  She's never had a weight problem before but by following their miraculous diabetic diet she's acquired a cholesterol issue, nearly a stone in weight and blood sugar through the roof after that much rice.  She won't know though because she doesn't test.  They won't know the error of their ways either, because progression is inevitable, nowt at all to do with their treatment protocols, no just a progressive condition.  Or a self fulfilling prophecy.


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## Northerner (Apr 20, 2016)

KookyCat said:


> There are plenty of T1s who don't help themselves either but they manage not to lump all of us together and assume we're all incapable (just), there will always be folk who want to close their eyes tight and shut out the reality, it's just the way it is.   There will also be those who go against the tide and self fund and test.  It's the middle ground, like the lady I work with, who are given the impression it's nothing serious, and they don't need to test and just need to follow doctors orders.  If her doctor told her to test she would, but because she's told she doesn't need to she won't.  Her A1C is way too high, and always has been, they're talking about insulin now because she's showing signs of neuropathy and retinopathy.  Now the doctor's tone has changed, diabetes is a progressive condition, inevitable, insulin is the only answer, the neuropathy is progressive etc etc and she's absolutely petrified and shocked, because the there there just do as you're told approach has led to this.  She's not a stupid woman, she's very bright in fact, but inordinately compliant.  If she'd been shown another way she would have done it.  Her lunch the other day was a tub of rice with veggies and boiled chicken, followed by two small satsuma things and a banana, just like the dietician ordered....when I asked if she enjoyed it she said no, I hate rice and fruit I'd much rather have a chicken Caesar salad and Greek yoghurt with almonds, but I'm not allowed.  I nearly fell off my chair.  The salad and yoghurt would be a much better choice.  She's never had a weight problem before but by following their miraculous diabetic diet she's acquired a cholesterol issue, nearly a stone in weight and blood sugar through the roof after that much rice.  She won't know though because she doesn't test.  They won't know the error of their ways either, because progression is inevitable, nowt at all to do with their treatment protocols, no just a progressive condition.  Or a self fulfilling prophecy.


You've nailed it there Kooky, it's not just the motivated people getting turned down, it's all the people (would it actually be a majority?) who are told that it's 'mild' and that their near-double figure HbA1c is 'good' - until it becomes 'serious' and 'concerning'  If the standard therapy was to test, with associated training and support, you may not save everyone but surely you would be providing better care and quality of life for those you did. Current advice practically amounts to negligence


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## everydayupsanddowns (Apr 20, 2016)

Absolutely agree. Most of the SMBG studies assume the advice being given is right and that BG tests are just to check whether you are eating the big-tub-of-rice as advised. And if your levels are high, well... then keep eating it. Madness.

There is also a prevailing train of thought that people simply will not change the way they eat in response to the information a meter provides (and as TW points out - there are many people who will confirm this thinking!). As you say @KookyCat - an entirely self-fulfilling prophecy.


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## @Fractis (Apr 20, 2016)

There are some very substantial flaws in the science being used here, as well as the implied economics.

It is based on a systematic review of many different trials (Malanda UL, et al, Cochrane Database Syst Rev. 2012 Jan 18;1:CD005060. doi: 10.1002/14651858.CD005060.pub3), and this was also used in establishing the NICE guidelines.

The review combines the results of 12 clinical trial, covering over 3,250 participants, aiming to look at all the data fairly, and drawing conclusions from all studies on the topic and overcoming concerns that individually the studies are not large enough to be significant.  Whilst this review process can give us confidence about the quality of the studies covered, and in theory increased certainty from the larger number of participants, it is clear from the start that the individual studies are very varied. Not only do the studies have diverse methods (not all studies provided instructions on how and when to test), but across the studies the frequency of testing varied between 4 times a months to 6 times a day. All studies looked at HbA1c as the outcome, but there was no consistent consideration of broader outcomes such as empowerment, patient distress, satisfaction with treatment and overall quality of life.

What is clearly missing in these studies is a common approach to structured education; how to successfully use regular testing to improve the patient’s knowledge of the condition. It is only through learning from the tests that we undertake that we can hope to improve our BG control, and far too many of these studies have failed to recognise this, or equip the participants with enough test strips to be meaningful. Without the tools to identify patterns in the results, the data gathered is of little use to a patient, and we should not be surprised that average BG levels are not improved.

It is not that there is no evidence to support testing, but rather that incomplete questions are being asked and the right sort of evidence has not been gathered and interpreted. As a community such an overwhelming number of us prove that testing not only has the ability to improve our lives and clinical outcomes, but also mitigate the high costs of treating complications. Provision of test strips in conjunction with the right education about using them should be considered as a cost saving measure fro the NHS.


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## Northerner (Apr 20, 2016)

We ought to get some researcher to trial what happens with GOOD education and dietary advice (i.e. the kind we see handed out, and working, on forums around the world! )


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## Annette (Apr 20, 2016)

Northerner said:


> We ought to get some researcher to trial what happens with GOOD education and dietary advice (i.e. the kind we see handed out, and working, on forums around the world! )


Right, so, we need to get in touch with researchers, explain what we think they need to do, get them to write a grant proposal to DUK, offer to help out by providing in depth knowledge of how it does work in practice, and then let the academic bods run with it. How do we do that? Who do we contact? Do DUK put out calls for specific research areas, or just wait for people to come to them? (Or JDRF, or anyone else).


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## everydayupsanddowns (Apr 20, 2016)

@Fractis said:


> What is clearly missing in these studies is a common approach to structured education; how to successfully use regular testing to improve the patient’s knowledge of the condition. It is only through learning from the tests that we undertake that we can hope to improve our BG control, and far too many of these studies have failed to recognise this, or equip the participants with enough test strips to be meaningful. Without the tools to identify patterns in the results, the data gathered is of little use to a patient, and we should not be surprised that average BG levels are not improved.



Absolutely spot on. That's it in a nutshell.


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## Northerner (Apr 20, 2016)

Annette Anderson said:


> Right, so, we need to get in touch with researchers, explain what we think they need to do, get them to write a grant proposal to DUK, offer to help out by providing in depth knowledge of how it does work in practice, and then let the academic bods run with it. How do we do that? Who do we contact? Do DUK put out calls for specific research areas, or just wait for people to come to them? (Or JDRF, or anyone else).


I'll try and find out


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## happydog (Apr 20, 2016)

Some T2s don't want to test and are reluctant to take control.  For those of us who do want to try testing is essential.  I would not be without it.  If doctors compared the cost of the drugs and expenses incurred dealing with the complications with the cost of strips it might encourage them.  Maybe light will dawn one day, we can live in hope


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## robert@fm (Apr 20, 2016)

Now that it's beginning to be realised that Ancel Keys was a massive fraud whose crackpot ideas _caused_ the obesity crisis, maybe some might come to realise that the "T2s don't need to test" mantra is a similar load of rubbish? Just as Keys carefully cherry-picked those 7 countries whose statistics appeared to support the conclusion he wanted (which is why the European ones don't include France nor Germany), so it seems that those devising guidelines for testing are interested only in studies which support their orthodoxy, and throw the rest out of the window.

This is known by the ironic name Proof by Selected Instances, and it's a logical fallacy _and_ a dishonest arguing trick.


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## Ralph-YK (Apr 20, 2016)

Northerner said:


> may cause anxiety NOT KNOWING


I'd say will, and I'd put it stronger than that.



Riri said:


> do they not understand that for most of us if we don't have the means to check what our blood sugars are doing, the heightened anxiety from that causes untold problems including stress with it's long term damaging effects.


I've already tried telling my practice this in relation to information generally and tests in particular, including affecting motivation and causing future problems.
[Edited to make corrections]


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## Ralph-YK (Apr 20, 2016)

robert@fm said:


> Ancel Keys


Who?


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## Ralph-YK (Apr 20, 2016)

happydog said:


> Some T2s don't want to test and are reluctant to take control.


Some of us are English and have difficulty taking to medical people and causing a fuss.  On top of not being about to talk about medical matters with them!  They'd test if it was offered.


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## Ralph-YK (Apr 20, 2016)

Northerner said:


> The NHS do have deal with suppliers, I think most of the major brands have been negotiated down to around £15 for 50 strips. Of course, now they are doing exclusive deals with cheap, lesser-known manufacturers so getting a better deal on them.


There's strips on Amazon at £8 for 50.  Are these rubbish and shouldn't be touched with a barge pole?  How come the NHS are paying £15?
There again, we're talking govenment purchasing practices.


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## Mark Parrott (Apr 20, 2016)

Those strips are for the Codefree.  A cheap but effective meter.  Does a good enough job.  I don't know why doctors/DSN's aren't prescribing these.  And if they order them direct from Home Health, they do 5 pots for the price of 4, so even cheaper.


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## robert@fm (Apr 20, 2016)

Ralph-YK said:


> robert@fm said:
> 
> 
> > Ancel Keys
> ...



https://forum.diabetes.org.uk/boards/threads/the-sugar-conspiracy.58708/ — mainly the link in the first post, although the other replies are also relevant.

And as well as pushing what is now beginning to be recognised as a crackpot stance, the NHS guidelines also have separate allowances for "natural" and "added" sugar, as if one of them is somehow tagged so that the body knows to handle it differently.


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## Ljc (Apr 20, 2016)

robert@fm said:


> https://forum.diabetes.org.uk/boards/threads/the-sugar-conspiracy.58708/ — mainly the link in the first post, although the other replies are also relevant.
> 
> And as well as pushing what is now beginning to be recognised as a crackpot stance, the NHS guidelines also have separate allowances for "natural" and "added" sugar, as if one of them is somehow tagged so that the body knows to handle it differently.


You mean that they haven't work it out that sugar is sugar no matter it's source  
Mind you little supprises me these days.


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## robert@fm (Apr 20, 2016)

Ljc said:


> You mean that they haven't work it out that sugar is sugar no matter it's source


Nor, as has often been repeated on these boards, have they realised that there's no practical difference between sugar and any other carb — it doesn't have to taste sweet to do damage.


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## @Fractis (Apr 21, 2016)

Annette Anderson said:


> Right, so, we need to get in touch with researchers, explain what we think they need to do, get them to write a grant proposal to DUK, offer to help out by providing in depth knowledge of how it does work in practice, and then let the academic bods run with it. How do we do that? Who do we contact? Do DUK put out calls for specific research areas, or just wait for people to come to them? (Or JDRF, or anyone else).



Unfortunately I have no idea how these things get done ("C" grade O Level in English literature in the early 1980's was the high water mark for me academically ) but it's not like we are short of potential trail participants...

I guess the costs involved in any study revolve around delivering the education component, and I wonder if that could piggy back on the NHS diabetes prevention program, which has made a big deal about evidence-based behaviour change, BG testing could be fitted into the intervention/education portion of the program.


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## Northerner (Apr 26, 2016)

Annette Anderson said:


> Right, so, we need to get in touch with researchers, explain what we think they need to do, get them to write a grant proposal to DUK, offer to help out by providing in depth knowledge of how it does work in practice, and then let the academic bods run with it. How do we do that? Who do we contact? Do DUK put out calls for specific research areas, or just wait for people to come to them? (Or JDRF, or anyone else).


Hi, Hannah at Diabetes UK has sent me the following information about this issue and how research gets given the go ahead and funded:


"A really interesting thread with some very valid points.  The ‘advantages’ and ‘disadvantages’ you have posted, I agree, are extremely skewed and do not really make a case for why you wouldn’t test!

In regards to self-monitoring and its relation and benefits to managing diabetes I can confirm that Diabetes UK is very much of the opinion that the cost of providing strips and helping people to maintain good glycaemic control is integral to preventing complications.

 We have recently developed an information guide to support people in their difficulties with obtaining strips, as we saw a sudden rise in queries about the issue.  Our response was the test-strip advocacy pack: https://www.diabetes.org.uk/Documents/Advocacy/test-strips-advocacy-pack-0613.pdf

You may find the Position Statements on Pages 3, 7 & 10 particularly useful.

In terms of the process for research, we hold applications twice a year for research proposals. These can be proposals from science students right through to professors specialised in their field.

Which projects are chosen to be funded is based on a number of things, but generally we aim to fund a variety of projects to benefit all types equally (some on T1, some on T2 etc) and to look at our three main goals – Care, Cure & Prevention.


The process:

-Applications made

-Shortlisted based on a range of criteria*

-Shortlist sent to 100s of specialists scientists in their field to question whether proposed research is scientifically viable –will the trial/research provide valid results etc.

-Best proposals are taken to panel of people living with diabetes to discuss benefits of each proposal and to prioritise them.

-The list then goes to a research panel for further review

-Final research projects are selected, with the aim to get the best out of the funding available - (this could be lots of small trials or a few big trials but the main thing is the quality and benefits they will provide).


It is summarised on our website in more details, please take a look: https://www.diabetes.org.uk/Research/Our-approach-to-research/


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## Curly grandma (Apr 28, 2016)

Have been to various T2 meetings since diagnosis in October last year and each time I mention that I monitor my blood Glucose , there's the same comment  "it will cause anxiety" and look at you like you are a heckler at a    Political meeting!!  I have learned a lot from these get togethers, but  more from the forum. 
Things are going well and my first HbA1c results down from 53 to 44, my weight is decreasing slowly, I don't feel I have to check my bloods as often because I am educated about diet, exercise, and what makes the results go higher.  I know it's early days and things could go differently in the future but I am prepared, NOT ignorant!!!   I know of two of my friends who are in denial still, months after diagnosis and they are experiencing  side effects already.  Both of them refuse to monitor because the nurse says so and are on medication.  One of them thinks he is very clever because he just has a whole pack of Uncle Bens for his tea!!!! Ugh???? 

We need to be Educated!!!   I was very anxious on diagnosis, but helped myself with your support. Thanks.


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## Northerner (Apr 28, 2016)

Curly grandma said:


> Have been to various T2 meetings since diagnosis in October last year and each time I mention that I monitor my blood Glucose , there's the same comment  "it will cause anxiety" and look at you like you are a heckler at a    Political meeting!!  I have learned a lot from these get togethers, but  more from the forum.
> Things are going well and my first HbA1c results down from 53 to 44, my weight is decreasing slowly, I don't feel I have to check my bloods as often because I am educated about diet, exercise, and what makes the results go higher.  I know it's early days and things could go differently in the future but I am prepared, NOT ignorant!!!   I know of two of my friends who are in denial still, months after diagnosis and they are experiencing  side effects already.  Both of them refuse to monitor because the nurse says so and are on medication.  One of them thinks he is very clever because he just has a whole pack of Uncle Bens for his tea!!!! Ugh????
> 
> We need to be Educated!!!   I was very anxious on diagnosis, but helped myself with your support. Thanks.


That's it exactly @Curly grandma  - education and understanding remove the anxieties, or at least go a long way towards it. This 'no testing' mantra is so entrenched - why, why, why can't they have got the RIGHT advice entrenched instead? Grrr!!!  Well done on your terrific success, your progress illustrates precisely what should happen to most Type 2s and improve their quality of life instead of potentially reducing it considerably.


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## Highlander (May 24, 2016)

My wife who is type 2, was told to stop testing and that no more strips were being provided.  We test meters for a company every now and again, so one day we were at the lab doing some testing and my wife had a reading of 19.5.  While this was shortly after eating, this was way higher than it should be.  If she was able to monitor, no way would her readings be this high.  Even her HbA1c has gone up quite a bit, so the Doc increased her metformin, which then made her quite ill.   In my opinion testing does help keep better control, removing strips is just down to cost and nothing else.


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## Ljc (May 24, 2016)

Highlander said:


> If she was able to monitor, no way would her readings be this high.  Even her HbA1c has gone up quite a bit, so the Doc increased her metformin, which then made her quite ill.   In my opinion testing does help keep better control, removing strips is just down to cost and nothing else.


I and I believe everyone here agree with you
It's very short sighted not to prescribe meters and enough test strips for all diabetics, IMO in the long run it would not only save lives and limbs but also save the NHS lots of money.  
It's a sad state of affairs when we here have to advise people to buy their own meter and strips.


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## Sydney Bristowe (May 24, 2016)

Curly grandma said:


> Have been to various T2 meetings since diagnosis in October last year and each time I mention that I monitor my blood Glucose , there's the same comment  "it will cause anxiety" and look at you like you are a heckler at a    Political meeting!!  I have learned a lot from these get togethers, but  more from the forum.



I totally agree. Even at the Diabetes UK Living with Diabetes event I got some very funny looks around the table when I was testing and one person asked me why i was testing so much - I'd had my diagnosis for about 4 weeks at this point and had self funded the Codefree while I was waiting for a response from my DN about if they would fund a meter for me. I found out that day that Banana's are no good for my levels!


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## Northerner (May 24, 2016)

Sydney Bristowe said:


> I totally agree. Even at the Diabetes UK Living with Diabetes event I got some very funny looks around the table when I was testing and one person asked me why i was testing so much - I'd had my diagnosis for about 4 weeks at this point and had self funded the Codefree while I was waiting for a response from my DN about if they would fund a meter for me. I found out that day that Banana's are no good for my levels!


Hope you educated them Sydney!


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## Ralph-YK (May 24, 2016)

The DSN at the Diabetes course/info thing was saying that she supports T2's testing.  Unforeturnatley, she works too far away from where I live for me to get assigned to her.


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## Matt Cycle (May 24, 2016)

Just playing devil's advocate here as I did some rough calculations and with a diabetic population in the UK of 4 million (all types), each testing 4 times a day with an average strip price of £20 for 50 would work out at £2.3 billion (yes, billion) per year in strips alone. 

Obviously not really sustainable in spite of the cost of complications and all the rest of it - that's probably seen as a cost that may not happen and someone else's problem.

I don't agree with it but you can see why they get twitchy at handing them out.


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## rustee2011 (May 24, 2016)

A real shame this good old country of ours don't want to invest in health...but find plenty of cash for arms and war......


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## Northerner (May 24, 2016)

Matt Cycle said:


> Just playing devil's advocate here as I did some rough calculations and with a diabetic population in the UK of 4 million (all types), each testing 4 times a day with an average strip price of £20 for 50 would work out at £2.3 billion (yes, billion) per year in strips alone.
> 
> Obviously not really sustainable in spite of the cost of complications and all the rest of it - that's probably seen as a cost that may not happen and someone else's problem.
> 
> I don't agree with it but you can see why they get twitchy at handing them out.


I did once see some figures for the actual breakdown of where the £10bn NHS annual spend on diabetes goes - I'll try and dig them out tomorrow, see if DUK can help  I know that strips are a fraction of the (mostly preventable) complication treatments.


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## Northerner (May 24, 2016)

rustee2011 said:


> A real shame this good old country of ours don't want to invest in health...but find plenty of cash for arms and war......


Indeed - how much do they want to pay for Trident renewal? Something that is actually worthless?


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## Matt Cycle (May 24, 2016)

I can't see anything changing.  There would be a period where strips were being issued to all at a huge cost but also still treating complications at a huge cost - double whammy.  You wouldn't see any benefit from testing in terms of reduced complications for some period of time in the meantime the government has probably changed.  It's all about the short term for them.


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## Northerner (May 25, 2016)

Matt Cycle said:


> I can't see anything changing.  There would be a period where strips were being issued to all at a huge cost but also still treating complications at a huge cost - double whammy.  You wouldn't see any benefit from testing in terms of reduced complications for some period of time in the meantime the government has probably changed.  It's all about the short term for them.


Indeed, it's why politics needs to be taken out of the NHS so they can plan long-term, not on an election cycle (or crisis-beg-crisis, as it seems to be these days )


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## Sydney Bristowe (May 27, 2016)

Northerner said:


> Indeed - how much do they want to pay for Trident renewal? Something that is actually worthless?



Trident renewal is essentially keeping the economy in the North West alive. It directly sustains 8,000 jobs with a further 10 jobs in the supply chain created for each direct job. Barrow would disappear without it and places like Preston and Lancaster would also massively suffer. It may be something that is seen as morally wrong by many and it's easy to make it a political scapegoat for the shortcomings of the current government on the NHS, but it is certainly not worthless. The money spent on it would never ever be routed to the NHS if it were cancelled because it would have to be used to shore up the economy

I do agree completely that politics should be removed from the NHS though. This government is actively trying to cripple a service that is the envy of the world. I'm so proud of the NHS and it makes me sad to see how it is being destroyed by distorted reporting and mis management at the most senior levels.


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## Eirian Jones (May 28, 2016)

Has anyone bought test strips?

The manufactures hold us (either individual purchaser or tax payer) to rand some.  NHS budgets can't pay for test strips for all?

Education is an interesting point, the take up of Expert (Type 2 Structured Education) is quite poor, although there are many complex reasons for this, so what makes anyone so sure people are going to be educated in interpreting the results?

The vast majority on non hypo inducing mess are at an early stage of their "Diabetes journey" so probably still have a great deal of complacency and would not show an interest in maintaining their health.

My solution is to give strips to those who show commitment to improving their health and Doctors or DSN's make that judgement.


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## Superheavy (May 28, 2016)

Hi Eirian, I was just talking to a friend of mine who is a GP and he was saying that they may be introducing a video course version of those expert courses, I'm hoping he'll send me a link so I can report back. Luckily enough, I get my strips from the GP, but they have suggested that as my levels are stable, that I don't need to test quite so regularly. I've never bought strips, but if I were I'd probably switch to the one with the cheapest strips. If everyone did that, the other manufacturers would soon be bringing their prices down.


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## grovesy (May 28, 2016)

I purchase strips occasionally as I only get 50 a month on prescription and I am on Glicazide. My current Microdot are around 15.00 for 50 to buy. I used to have a one touch and the strips were 25.00 for 50.
Many on here use the Codefree as it is the cheapest meter around.


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## Northerner (May 28, 2016)

Eirian Jones said:


> My solution is to give strips to those who show commitment to improving their health and Doctors or DSN's make that judgement.


That would be fine if they actually recognised that commitment, but unfortunately a very large number of them dismiss it and have their 'judgement' clouded by short-term savings  Personally, I think anyone who comes looking for help and support on a forum is already showing commitment to getting their levels under control, but time and again the same story is told that the GP/nurse says 'you don't need to test'


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## Ralph-YK (May 28, 2016)

Eirian Jones said:


> Has anyone bought test strips?


I have. £8 for 50.



Eirian Jones said:


> Education is an interesting point, the take up of Expert (Type 2 Structured Education) is quite poor, although there are many complex reasons for this, so what makes anyone so sure people are going to be educated in interpreting the results?


I only knew about it because I'd managed to find this forum and heard it mentioned here.  I had to self refere.  (Although I missed it, as there is a different local provision now).  As for people getting training in interpreting the results, that's down to NHS staff.  I've had dismissive, condisending health professionals dealing with me.  They're not interested or bothered about you knowing anything or managing your condition. This sort of thing undermines diabetics managing their condition.  From what I can tell it depends on the area you are in.


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