# Type 2 testing



## Andy HB (Oct 5, 2015)

We get lots of new type 2 members being told by medical types, who should know better, that they don't need to test for various reasons (but never for the real one, that they are trying to save money. Even though, down the line it will end up costing the Nhs more!).

Anyway, my experience of this issue is diametrically opposed to their experiences and was a large contributor to my improvement following diagnosis. 

The DSN at the hospital I was taken to when diagnosed gave me a meter and told be how to use it plus the BG ranges to aim for. My testing regime was as follows:

1) Test once per day at different times. That is, when I get up, before or two hours after meals or before going to bed. The after meal testing usually being 2hrs after.

2) The BG ranges to aim for:
4 to 7mmol/L --> Fasting or before meals
7 to 9mmol/L --> 2hrs after meals
<4mmol/L --> Hypo (Avoid)
>10mmol/L --> Hyper (Avoid)

If I was ever in hypo territory (unusual), I just ate something sweet (I had some glucose tablets for that purpose). If I was in hyper territory, I went for a walk to bring it down (retesting once to confirm).

In addition, I also supplemented this approach with testing before and 2hrs after certain meals to see how they affected me. This was especially true for some cereals which I eventually dropped from my diet because they sent me high without fail. I didn't do this too frequently because it does eat up the test strips.

Anyway, this approach served me well and kept my test strip use down. After a while testing became less and less necessary and the annual Hba1c test confirmed that I remained pretty much on the straight and narrow. I basically don' t need to test any more. But, that is only because testing gave me the knowledge of which things to avoid and also how to live my life with this condition. This is something that those denying health professionals (or health denying professionals) don't seem to understand.

Finally, what I described above only really works for people whose diabetes is generally well behaved and improving. For those where the levels are all over the place, it is even more vital that testing is used more aggressively to inform the person what is sending them high. Only then can they hope to begin to improve or atleast inform those who can help (something an Hba1c test can never do).

So, how do others, who are lucky enough to test, test themselves and do they find it useful? Also, is there anyone out there who were told to test but not told what the test means or what to do with that information (because that is just as daft as being told not to test).

Andy


----------



## Stitch147 (Oct 5, 2015)

I have recently been diagnosed as type 2 (my fasting reading was just over 19) and when I went to see the nurse then the dr nothing was mentioned about testing my BG levels. Which I was surprised at. I have since got a BG tester after seeing a different doctor and they told me the best way and times to test. He also explained that it would be good for me to see what foods affected my BG levels and to adjust diet as i saw fit. I mainly test twice a day at the moment, once when I get up (fasting) then 2 hours after my evening meal. Last week I went back to my dr as I wasnt seeing any signs of changes to my BG levels so thdr looked at the record that I had been keeping and upped my metformin dosage. I like to test mine as my levels were and are still so high, I want to know that I am doing the right thing to reduce my BG levels, without regular testing I would never know.


----------



## Pine Marten (Oct 5, 2015)

Excellent post, Andy. I test when I get up, usually before & after evening meals (especially if it's something we haven't tried before) and before bed. I also test before & after exercise, though I don't manage to do my exercises every day, it's more like twice a week at the moment.

I like to test several times just to confirm what foods affect me, so sometimes it's a bit pointless, I suppose, but it all gets written down in my food diary, so it pleases me to cast an eye over it and see what progress (or not!) I've made over the months.

My D nurse is always very encouraged to hear about this and supports my efforts, but the GPs still won't provide a meter or strips, even though they say I'm very good at controlling my levels (seems daft, doesn't it?).

Most of what I know about testing comes from info on this forum and the links people provide.


----------



## Amigo (Oct 5, 2015)

My experience mirrors yours Andy and I test in the same way as Pine Marten.

My GP gave me a meter at diagnosis and has been very amenable to providing a generous amount of testing strips every two months. I've just had my first review since diagnosis in Feb and by regular testing and 'eating by the meter', I've learned exactly what I can and can't eat and adapt accordingly. My last HbA1c was 41 and the nurse said that it's my diabetes and I must care for it as I see fit and right for me. Brilliant response! 

I'm now scaling down the testing but because of my other condition (which I don't want to keep harping on about), it's essential that I am aware of infection possibilities early. Perhaps that's why my surgery are being more amenable to me but all Type 2's should receive this essential monitoring especially in the early stages of diagnosis. It's false economy otherwise.


----------



## Worcester_Matt (Oct 5, 2015)

That's really interesting Andy. I admit to being sceptical about the value of testing for non-insulin dependent diabetics, solely for the reason that I think it has the potential to become an unhealthy obsession when it needn't be. If I didn't have to inject insulin and if there wasn't the corresponding risk of a hypo, then I wouldn't test. I'm sceptical about the immediate rush to "test test test" for anyone diagnosed with diabetes, but if someone wants to do it and they've been diagnosed I think the NHS should fully support them.

I really hadn't considered it from the perspective you present, and it's a very interesting defence of the value of testing. I wonder if someone at Diabetes UK (or any other relevant support group/charity) would be interested in reading it as something they could use to try and persuade more GPs/CCGs to support testing for type 2 diabetics? My Trust have an excellent attitude towards diabetics (type 1s at least, I have no experience of their attitude towards type 2 but I presume it's similar), which is that they will move heaven and earth to support you before you get to the stage of requiring hospitalisation. From a purely financial perspective, hospital treatment is vastly more expensive in terms of time and money than a testing meter and a box of strips every week or two. 

Thanks for your post anyway!


----------



## trophywench (Oct 5, 2015)

Matt I diametrically disagree with you!

We ALL need to Test, Review, ADJUST.  

There is no point whatsoever of any diabetic merely doing the first bit - without the other two!


----------



## trophywench (Oct 5, 2015)

And I'll also add, to you personally Matt,  if you don't do it, how are YOU going to discover whether your basal insulin dose is working correctly and optimally for the full 24/7 ?


----------



## Annette (Oct 5, 2015)

The trouble is, though, that many Type 2's can't (or maybe don't know how to) ADJUST. Its not as easy as changing the insulin.
And if the HbA1C is not outrageous, the healthcare provider wont necessarily be amenable to looking at changing tablets or any other action.
For example: my brother in law has T2. My sister does all his care following his stroke. She religiously tests because (a) her GP is quite happy to let her have strips and (b) having grown up with me testing many times a day, she is of the mindset that it is part of his care. However, no-one at her surgery has ever told her what to do with the tests. They don't really look at her records, other than cursorily (she has a decent nurse who does look, but doesn't really tell her what to do with them.). I went through with her how to work out what foods agree/disagree with his, and she has done that - and now avoids certain things. But other than that (eg avoid white bread and mashed potatoes), there is little she can do to affect his bg levels. Most foods have little effect. Exercise is out (due to the stroke). So she CANT adjust anything. So should she just give up testing? No, obviously not. But she doesn't really know what to do with the results, and I don't know what else to tell her.


----------



## Amigo (Oct 5, 2015)

Matt, I'm afraid I do too! No personal offence however, we all have our views. 

I do wonder where this notion originates from that Type 2's have more potential to become obsessive with the testing strips. To start with it hurts! 

I despair of the Type 2's I meet who struggle to see cause and effect between endless slabs of cake and generally feeling crap. And that's because they're never trusted with procuring the evidence for themselves. It allows for too much damaging denial!

 It was a total eye opener to me and still shocks me at times when I think a little treat won't hurt, won't register and might not matter. And then I see the meter evidence and it's a constant wake up call! Ok arguably it's an expensive 'conscience meter' for the NHS to fund but it means I stay off meds and don't end up in hospital like I did last year, undiagnosed and costing a fortune as an in-patient. 

I take the view that every hike matters and has the potential to harm me but testing gives me no pleasure, it's just an absolute necessity. It allows me to take control and head problems off and address foods that simply send my levels soaring. Even now I occasionally find the most unusual thing does that.

I agree that there are people who don't want to do it and actually couldn't cope but purely from my experience, I find that the Type 2's who struggle, are often the people who don't test and see the 'diabetic experience' as being a 3/6 monthly check and pleasing the medic. It's not. To me it's a meal by meal experience because unfortunately it has to be. And if I'm ever tempted to forget that, I remember being marooned on a wall on holiday last year with numb feet, aching legs and dying for a pee! 

I'd push anyone to test. It's the only way to be in true control of whatever kind of diabetes you have.

Apologies for the rant!


----------



## AlisonM (Oct 5, 2015)

Perhaps my view is coloured by the fact that I was initially diagnosed as T2, but I'm afraid I disagree strongly with this notion that Type 2s might get 'obsessed' with testing, frankly it's rather insulting. No one in their right mind *wants* to do all that finger pricking, it's a fairy tale put about to discourage them and encourage the false economy that could so easily cost a lot more in the long run when the NHS ends up dealing with the consequences of uncontrolled blood sugar levels. If Type 2s were given the tools to test and interpret the results, those costs could be greatly reduced and the quality of life of thousands hugely improved.

Testing is a vital tool for *any* diabetic, no matter what type they are and should be available to all as a matter of routine. Maybe T2s won't need to test as often once they've learned what's safe and what to avoid - a huge relief to them I don't doubt, but they should be given the opportunity, just like the rest of us.


----------



## Annette (Oct 5, 2015)

So Amigo, what do you DO with your numbers (other than the ones that test if a certain food/treat is good/bad for your levels)?
What can I tell my sister that T2s do with their records? She's desperate to keep my B-I-L off insulin (because he would be unable to tell her if he went hypo, and if he collapsed, she would be unable to get him up - he's a big lad) and testing is a big part of that. But exactly how does a T2 use those numbers?
How do your numbers allow you "to be in true control of whatever kind of diabetes you have"?


----------



## AlisonM (Oct 5, 2015)

Test, review and adjust Annette. For a T2, diet is the most important consideration and testing blood sugar levels should be used as a tool to establish which foods are the greatest offenders. Different foods affect us all in different ways and establishing exactly what happens is key to good control.

*Alan Shanley's blog: Type 2 Diabetes - A Personal Journey* Is a great guide if your sister wants to help your BIL control his diabetes.


----------



## Northerner (Oct 5, 2015)

AlisonM said:


> Test, review and adjust Annette. For a T2, diet is the most important consideration and testing blood sugar levels should be used as a tool to establish which foods are the greatest offenders. Different foods affect us all in different ways and establishing exactly what happens is key to good control.
> 
> *Alan Shanley's blog: Type 2 Diabetes - A Personal Journey* Is a great guide if your sister wants to help your BIL control his diabetes.



Precisely Alison, the logic of that approach is irrefutable, and I would say that practically every T2 who has taken that approach has been far more successful than simply following the 'HbA1c/extra medication' route. 

For me, if GPs and nurses are concerned that a person might be obsessive or not use the strips correctly (another argument against issuing them is that they lie on a shelf and never get used), then simply call them in periodically to go through the numbers on the meter. This sort of inclusinve approach would be far better for the patient, who wouldn't feel they were being left on their own as many do, and also show that there are practical steps that can be taken to improve things.

Instead, we hear so many tales of T2s being give 6-monthly or annual HbA1c's and get told they are fine even if they are high, because the nurses and doctors are used to seeing high numbers and think there's nothing that can be done and it's the patient's own fault anyway...rant over!


----------



## Amigo (Oct 5, 2015)

Hi Annette,

I keep my own records to guide and advise me. It's made me aware of which foods are hazardous for me and in what amount and combination. I've realised I just can't eat pastry and I've had to take certain cereals off the menu. I'm not obsessive and don't have the scales out but testing over time has helped me to understand my own unique tolerance profile and how certain daily activities contribute. I'd never have known without testing. I'd have cheated to be honest!

How I use testing is to manage and adjust my diet and exercise levels. And I also use the meter as a barometer to my general health because I've found that it is. I appreciate that my situation may be slightly different because I have leukaemia and that means I'm highly susceptible to infection. As a result my BG rises with infection so I need to watch for that. When my BG's were high last year, I had tachycardia but they didn't see the link at the time. Infection in me can occur and develop rapidly and it's amazing how the glucose meter can pick up the rising signs. Through testing I've also discovered that my stress levels have a direct impact on my BG levels and if possible I take measures to relax or remove myself from situations when that happens. I'd try to exercise, drink more water and adapt my diet for the rest of the day.

I appreciate it's different for us all and I understand what you're saying about your brother in law. I took myself off metformin so I have to exercise more self control (the GP agreed incidentally). 

It just allows me to confront my 'enemy' directly. I can't do a thing about the rising levels driving my other condition so maybe I'm just pleased that this is a condition I can assess, plan for and take some degree (but not total) control over.

Regards, Amigo


----------



## Worcester_Matt (Oct 5, 2015)

Hi all,

Sorry if I've offended anyone, and I really didn't mean to suggest that any type 2 diabetic is more susceptible to becoming obsessed with testing than anyone else. My own personal experience in the short time I've been diagnosed is that I can become quite obsessed with testing my blood and constantly wondering what my glucose levels are. If I feel warm, cold, a little tired, hungry, thirsty... If I wake up in the night, sneeze etc I'm always thinking "is this my glucose level"? I'm well aware that this is certainly not going to be everyone's experience. My worry is that the instant someone comes on the forum and says they're a newly diagnosed type 2 diabetic the instant advice is "test test test" as if it's a universal positive, without any reflection that it certainly wouldn't be right for everyone. My mum, for example, is a type 2 diabetic and she's petrified of the idea of testing. I share an office at work with someone who has a completely different medical condition, but she's absolutely needle phobic, and even my testing kit is too much for her to bear. 

As I said in my original post, I suppose I hadn't really thought about the benefits of testing from the perspective that others have put forward, and that's really interesting to me. The point I was making about my own situation was that if I wasn't a type 1 diabetic, and I wasn't reliant on insulin, I doubt that I would test, so I wouldn't have any insulin injections to adjust. To put it into perspective, I'm 27. I hope to live for another 50 years (at least). That's 73'000 tests (even based on 4 tests per day, the bare minimum). Suggesting that people test before and after every meal (which is what I've seen people suggest in the past) puts that up to around 8 a day. That's 146'000 tests. That's a lot. I suppose I had never considered that someone's need to test might diminish over time. 

Anyway, I hope I've not offended anyone and I've really found it interesting reading the posts on this thread, particularly yours Amigo. One thing diabetes has taught me very quickly is to be very conscious of what's going into my body, and how that affects my body. I guess what scares me is a propensity to become overly obsessed with that, and the testing that goes along with it. I've said on a different thread that although we're all diabetics and obviously have to live our lives according to that, we could all be run over by a bus tomorrow.


----------



## Amigo (Oct 5, 2015)

No offence taken Matt and if I was 27 and in otherwise good health with longevity on my side, I'd probably take exactly the same approach as you.

Unfortunately I feel like that bus has already run over me with my diagnosis so I'm just taking measures to make sure it doesn't reverse over me again!


----------



## Annette (Oct 5, 2015)

Alison - yes, but adjust what? Hence my question to Amigo. 
My sister already knows what foods are killer for him (white bread, well cooked rice, mashed potatoes, fruit juice, fruit in general, although an apple doesn't hurt too much it appears - must be the skin etc slowing it down). So there really is little else on the food front she can adjust. (except for the alcohol, which she is trying to stop other people giving him - he doesn't know how to say no, you see.)
She is trying to get him out on a walk every day, but he manages no more than 20 minutes before he is literally too tired to continue.
She is trying to get his weight down - with small success.
I really feel that, other than Amigo's point about rising bgs indicating ill health (which is a good point, his numerous health problems perhaps put him in a similar boat to you, Amigo) there's not much more that she can do - and so just doing one test a day, to give her an idea what is happening, and increasing if there seems to be a problem, is sufficient for her/his needs.
I suppose my point is here, that although I totally agree that, to begin with, lots of testing is needed, there may well arise a point where further intensive testing wont tell you anything else, and a reduction to one a day (or even less, if you're not on medication?) doesn't mean you're giving in or giving up or not caring, which is the impression that can be seen to be being given.


----------



## AlisonM (Oct 5, 2015)

Sounds as if she's doing everything possible for him re diet and exercise already Annette. What medications is he on? They have a huge bearing on numbers and weight loss/gain and BGs as well. Not just diabetic meds, all of them. Perhaps a review of anything he's on in that line is called for, taking possible interactions into account too. Given all you've said, it's all I can think of that's left to look at.

Nobody is suggesting T2s need to test intensively forever, but to deny them the opportunity to test at all as a cost cutting measure while suggesting it's because they'll get obsessed (this is something my GP actually said to me in the early days) is extremely short-sighted of the medical profession. And sadly, this is something many T2s face at diagnosis, they're left to struggle in the dark without vital tools and information that could help.


----------



## Worcester_Matt (Oct 5, 2015)

AlisonM said:


> Nobody is suggesting T2s need to test intensively forever, but to deny them the opportunity to test at all as a cost cutting measure while suggesting it's because they'll get obsessed (this is something my GP actually said to me in the early days) is extremely short-sighted of the medical profession. And sadly, this is something many T2s face at diagnosis, they're left to struggle in the dark without vital tools and information that could help.



I couldn't agree more. If any diabetic wants to test, regardless of what "type" they have, then I think the medical profession has a duty to support them and help them do that.


----------



## Northerner (Oct 5, 2015)

Worcester_Matt said:


> I couldn't agree more. If any diabetic wants to test, regardless of what "type" they have, then I think the medical profession has a duty to support them and help them do that.



That's certainly the point Matt, what really gets my goat is when someone is highly-motivated to test, but is denied the opportunity based on some sweeping generalisation. The 'obsessive' argument is similar to the 'depression' argument i.e. that seeing bad numbers would just depress you, both came out of an old study that was done a while ago. In the study, however, the participants were not allowed to act on the data! 

Each person is supposed to be assessed on an individual basis - if they really don't want to test, as many, many people don't, then fair enough, but it's important that people know the alternative argument so they can make an informed decision - and be supported in that decision. With so many people there is no explanation offered at all.

The counter-argument to the 'depression' one is that, for some people not knowing what is happening can be more stressful and depressing - hence why a blanket ban should not be applied.

You certainly didn't cause any offence by voicing your opinion, so please don't feel that you might have done


----------



## AlisonM (Oct 5, 2015)

Sorry Matt, I should have said I wasn't offended by your post. The insult I was referring to is not yours, but lies with those professionals who use 'obsession' as an excuse when they haven't courage to say "it's a cost issue". However short-sighted, that at least would be honest.


----------



## Annette (Oct 5, 2015)

I take your point Alison, and will suggest that my sister ask for a total medication review (metformin,glicazide, statins, blood pressure,  and i think others i am not aware of!). 
On a similar point, my dad was told be didnt need to test any more (T2 for about 10 years), because there wasnt any point. Ummm? I was furious when I heard that! She (nurse) said it wasnt cost saving, just no point. How many people just take that as a direction-and Im afraid that includes my dad-as you do what the nhs tell you?


----------



## AndBreathe (Oct 5, 2015)

In my view, any newly diagnosed diabetic who doesn't test will be extremely luck to make a material difference to their condition.  That coupled with advice to eat a low fat diet and give up cakes, we really do have some hurdles to drag ourselves across.  That sort of approach is a bit like giving someone a book to read, the putting a blindfold over their eyes.

Relating to testing, I have not yet encountered a HCP, who when asked if they would
rely purely on a periodic HbA1c test to measure their progress has responded "Yes, absolutely".  Curiously enough, there is usually an eerie silence and much shuffling from buttock to buttock.

What I find more offensive than anything else is that these same HCPs can't just tell us why our testing isn't supported.  Frankly, the truth usually works!  There are so many stories in the press almost every day, of some drug or the other being withdrawn, often from people with life limiting conditions that it would be really difficult to argue cogently against the truth.  The truth is, according to a Consultant I was talking to, socially a couple of weeks ago, is the test strips constitute the greatest cost in diabetes care, but quite some margin.  I have no reason to disbelieve him.  

With the benefit of testing, I reduced my HbA1c from 73 in October 2013 to 37 at the beginning of February 2014.  Since then, it has measured at 34, 33, 32, 33 and 31 in May.  I have been removed from the diabetic register on the understanding I will continue to have an annual HbA1c, in recognition of my lifelong risk to re-crossing the line.  I have never been prescribed strips, and have actually been instructed not pt purchase my own.  I'm afraid for someone as stubborn as me, that was never going to be a top approach to take.

If I could just make a couple of points to Annette.  I have no idea what levels your BiL runs at, so it is difficult to gauge what potential there could be for improvement.  Undoubtedly, if he is unwell and less mobile, that will impact on his ability to exercise, which is unfortunate.  But, it is my firmly held belief that exercise for most T2s is the gloss on their approach to diabetes.  Diet far out-weighs exercise, in terms of all-day, every day impact on blood glucose.

In terms of what your sister might try to move her husband’s blood scores, I would potentially suggest portion sizes and also tweaking the content of the plate – more of what doesn’t raise his bloods, and moderating what does.  If that means his plate sometimes looks a bit different to everyone else’s, then so be it.  She could also change the frequency with which he is served his “star” meals – that is, those to which his bloods react extremely favourably.  Most people have them.  For me, that would mean more omelettes or fritatta.  I can almost guarantee my post-prandial blood score would be less than pre-prandials following an omelette.  Sometimes small changes, applied consistently and often, can have a decent impact.

But, to sum up:   Dealing with this condition is all about understanding, one’s own body, and recognising that because “my friend” can eat bread, rice, pasta or whatever means little to me, and taking responsibility for educating oneself.  Without the tools to do that there will be carnage.  

If my “obsession” means I get to keep my feet, and sight, and I can continue to live a full and energetic life, then I’ll be a happy obsessive.  

Did I ever mention, I hate labels, with a passion?


----------



## AndBreathe (Oct 5, 2015)

Whilst I’m on a rambling roll, Andy, why do you avoid going under 4 (initial post), if you are controlled purely by D&E?


----------



## KookyCat (Oct 5, 2015)

I think there's another point to consider.  Its one I've had to deal with with my friend who was diagnosed with T2 and didn't take to it too well (that's a massive understatement).  If you inject insulin you have to test to make sure you don't inadvertently knock yourself off your perch with too much insulin.  The need is very immediate as is the course of action.  You can't hide from a double figure reading caused by jelly and icecream.  What I'm trying to say and I'm not doing it well is testing makes it real, you see the cause and effect, and there's nothing like a 19.4 to make you re-evaluate whether you really needed all that rice.  Denying people with type 2 test strips encourages an unhealthy distance between cause and effect but more importantly it denies people the opportunity to monitor their condition.  Type 2 isn't a condition you can just ignore, pop a pill for and carry on regardless, it's something that needs monitoring and HBA1c isn't meant for that.  I think we're doing people a huge disservice in allowing them to believe that they can or should be less active in their management than someone who injects insulin.  Then I also admit I'm biased.  Type 2, that "less serious" diabetes is the reason I don't have my lovely sweet Dad anymore.  Seems pretty damned serious to me.


----------



## Matt Cycle (Oct 5, 2015)

AndBreathe said:


> The truth is, according to a Consultant I was talking to, socially a couple of weeks ago, is the test strips constitute the greatest cost in diabetes care, but quite some margin.  I have no reason to disbelieve him.



I can believe this.  As a rough calculation of the 3.2 million UK diabetics (all types) testing 4 times day using strips at an average cost of £15 for 50 equates to annual spend on test strips alone of £1.4 billion. 

A number test a lot more than this, some less, a lot don't get any strips and buy their own but the potential cost is staggering.


----------



## Amigo (Oct 5, 2015)

Totally singing from exactly the same hymn sheet Andbreathe & kooky! 

I keep being told you're never removed from the diabetic register Andbreathe so well done for that achievement! You inspire me!


----------



## AlisonM (Oct 5, 2015)

I have a T2 acquaintance who believes the nurse who tells him he needs to eat plenty of carbs and also believes the cinnamon capsule he takes every day is going to cure him. Then he's all confused when he gets lectured about not trying hard enough at every review because his HbA is horrendous. He's been told he doesn't need to test as it would only worry him. He should be bl***y worried as he's facing the loss of a foot due to D complications. I've tried, oh how I've tried but it's no use, it doesn't penetrate at all. He doesn't "want to get into all that stuff, it's too difficult" 

It's all so sad and could have been avoided with a little proper education.


----------



## AndBreathe (Oct 5, 2015)

Amigo said:


> Totally singing from exactly the same hymn sheet Andbreathe & kooky!
> 
> I keep being told you're never removed from the diabetic register Andbreathe so well done for that achievement! You inspire me!




Well, I didn't ask to be removed, my GP asked if I would like to be.  She then had to work out how to do it, as she hadn't known it happen before.  She is pretty young though.  

She is learning, having attended a few sessions of my GP interactive learning programme.


----------



## Northerner (Oct 5, 2015)

AndBreathe said:


> ..The truth is, according to a Consultant I was talking to, socially a couple of weeks ago, is the test strips constitute the greatest cost in diabetes care, but quite some margin.  I have no reason to disbelieve him.  ...





Matt Cycle said:


> I can believe this.  As a rough calculation of the 3.2 million UK diabetics (all types) testing 4 times day using strips at an average cost of £15 for 50 equates to annual spend on test strips alone of £1.4 billion. ...



Actually, the bulk of the cost of diabetes is down to treating complications. In 2010/11 the total cost of diabetes to the NHS was £9.8bn. Of that Treatment constituted £2.1bn and Complications £7.7bn. Given that it is estimated that 80% of complications are avoidable with better care, well over half the budget could be saved if people were just given better education, the tools they need, and better monitoring. THIS is why it is such a nonsense to save money on test strips for a very short term saving.  Bearing in mind also the huge human suffering and loss of quality of life caused by those complications, it is almost criminal in my opinion. 

OK, a small fraction of people might become a bit obsessive or maybe depressed at high numbers, but imagine how many people - on a daily basis - are living with the consequences of poorly-controlled diabetes, unable to walk, in constant pain from neuropathy, with failing kidneys and going blind - how depressed are those people likely to feel? A lot worse, I would suggest, than if they saw some poor numbers, but were then guided by a professional or mentor to recognise how to use the information and not fear it.

Here are the figures:

https://www.diabetes.org.uk/Documents/Diabetes UK Cost of Diabetes Report.pdf


----------



## Worcester_Matt (Oct 5, 2015)

I totally agree Alan, and those costs are staggering. But rather than try to cut down the costs through much better treatment, it seems demonising diabetics through the media is the NHS' preferred choice. 

I've learnt an awful lot from this thread about the value of testing. Now if someone could just stop it hurting when I prick my finger we'd be sorted... My DSN did once tell me that there are special prickers you can get that are usable for 'alternative sites', but we didn't really explore it. I'd be interested to know if anyone does use somewhere other than their fingers. The nurse did say there is a reason why we need to use our fingers, but I can't remember what it was.


----------



## Ted Hayman (Oct 5, 2015)

Sailing in strange waters, without a chart or a compass!
Why have I said the above? Because that's exactly how I feel right now!
Diagnosed T2 last month, cast adrift with very little information apart from a recommendation from the doctor I saw to make use of the www.diabetes.org.uk website. 
Had to make my own appointment to see a specialist diabetes nurse who, it turns out, was nothing of the sort!
Didn't seem to appreciate why I was there and sent me on my way with a handful of pamphlets and booklets about diabetes and diet. Oh, I almost forgot, she told me I'd be tested in three months time!
So, between now and then I'm pretty much left to my own devices, no personal testing for me, it seems.
If diabetes is so bloody serious in this country, why is the care for this condition so damn pathetic!

Sorry about swearing, but I'm pretty angry and extremely frustrated.


----------



## Northerner (Oct 5, 2015)

Ted Hayman said:


> Sailing in strange waters, without a chart or a compass!
> Why have I said the above? Because that's exactly how I feel right now!
> Diagnosed T2 last month, cast adrift with very little information apart from a recommendation from the doctor I saw to make use of the www.diabetes.org.uk website.
> Had to make my own appointment to see a specialist diabetes nurse who, it turns out, was nothing of the sort!
> ...



I hear what you are saying Ted, and it is wrong  The problem is that much energy and money is put into demonising diabetes to try and prevent people from getting it, but the message is vastly oversimplified (it's because you're fat and lazy), carries feelings of guilt from those who do get diagnosed, and it isn't even working anyway as the nation continues to gain weight regardless. Meanwhile, even many healthcare professionals believe that you could cure yourself if only you'd lose weight and that you're wasting their time. No-one gains from such a situation 

The care for people with diabetes varies vastly from place to place - even from surgery to surgery. Some places 'do it by the numbers', following a tick-box path that takes no account of individual needs and circumstances. Some, however, are excellent and do a great job of helping people understand their condition and controlling it.

We shouldn't forget, of course, that there are many, many people who won't follow a doctor's advice, however good it is, but at least they should get good advice and support in the first place, which often doesn't happen. I know that my auntie receives virtually no care, having been diagnosed three years ago. All she has received was a scribbled note in amongst other correspondence that she had Type 2, and a small leaflet with information that has been discredited for decades! In three years she has never even discussed her Type 2 with a doctor.


----------



## Andy HB (Oct 5, 2015)

AndBreathe said:


> Whilst I’m on a rambling roll, Andy, why do you avoid going under 4 (initial post), if you are controlled purely by D&E?



Well. I am diet and exercise only now. I was on gliclazide and then metformin when diagnosed and given those BG ranges to aim for.

If I was still testing and found that I was under 4mmol/L now, it would usually be because I was hungry and had just come back from a walk! 

I would probably want to be eating something then anyway.

Andy


----------



## trophywench (Oct 5, 2015)

Matt - have you read Alan Shanley's blog entitled 'Painless Pricks' ?

Sounds like you need to!

http://loraldiabetes.blogspot.co.uk/2006/10/painless-pricks.html

Incidentally though most of my pricks are painless anyway, I once had a meter supplied with a stabber that had two 'ends' - a normal one for fingers and a different one for alternative sites.  Forearms were a suggestion.  Well you never know, do you? - so I tried it.

ShShSheeeeettt!

Hurt like stink and to add insult to injury - no sodding blood appeared.


----------



## Matt Cycle (Oct 5, 2015)

Talking of finger pricking - does anyone else remember this little beauty?  I was still using it well into the 90's.






The Owen Mumford Autolet - all in full view unlike todays hidden devices.  It was wound all the way back and then released and had a deadly rattling spring sound before the lancet hit.  It was like a mini guillotine - an instrument of torture!!


----------



## Northerner (Oct 6, 2015)

That's put in an appearance a few times in the Diabetes Hall of Horror, Matt! 

I use (and a lot of others here also recommend) the AccuChek Multiclix by Roche - generally no pain fingerpricks


----------



## AndBreathe (Oct 6, 2015)

Thanks for clarifying Andy.

My only concern would be that someone inexperienced might think they really should never go under 4.  I don't know if there's any way of clarifying that in your initial post, because I think otherwise it's potentially a decent summary to point newbies towards?

(Sorry, sorry,........ I hardly contrinute, then spend all my time asking you to change something.  Hey ho.  )


----------



## Andy HB (Oct 6, 2015)

AndBreathe said:


> Thanks for clarifying Andy.
> 
> My only concern would be that someone inexperienced might think they really should never go under 4.  I don't know if there's any way of clarifying that in your initial post, because I think otherwise it's potentially a decent summary to point newbies towards?
> 
> (Sorry, sorry,........ I hardly contrinute, then spend all my time asking you to change something.  Hey ho.  )



I'm not sure that I actually want to correct myself. I think it is reasonable to set a lower limit to glucose levels (you have to set it somewhere and 4 is a reasonable level to set it at). 

But you are right that someone new to diabetes should not necessarily be panicked going a little under 4. It all depends on the context (medication, how recently one ate, exercise etc)

However, am I not correct that if someone is a driver they must actually be above 5 before getting behind the wheel if they are on insulin or other medication which stimulates insulin production (like gliclazide)?

Andy


----------



## AndBreathe (Oct 6, 2015)

No problem.  Your choice.

You are correct about drivers on potentially hypo inducing drugs.  I take no issue with that whatsoever.

I guess I'm just sensitive to having observed many T2s, getting their bloods into order, finding themselves under 4, but feeling fine, having a decent old panic and heading straight to glucose tablets, when what is actually happening is their body is just beginning to perform as it should.  To be fair, I did have a bit of a flap myself, first time I went below 3, and just about to go to bed.  My additional complication was we were several miles off-shore, sailing at the time (the wonders of sophisticated wi-fi arrangements!).

I'm also somewhat odd, in that these days I do run pretty low most of the time.  Wearing the Libre for a while was extremely educational, as it showed lots of really low scores, but hardly any spikes.  I thought I might see some short, sharp spikes, but didn't.

I have come to the conclusion that for me, my normal, healthy, slim-line running scores are at the lower end of normo-glycaemic ranges, and I'll stick with that, whilst I feel fine, have no ill-effects and maintain a low HbA1c.

It's all a personal voyage of discovery.


----------



## Worcester_Matt (Oct 6, 2015)

I may be wrong here, but I'm sure Andy is right (certainly is about the driving). No diabetic should accept that a glucose level of less than 4 is 'normal' or acceptable. If any diabetic is below 4, and certainly below 3, they should be rushing for the glucose tablets.


----------



## AndBreathe (Oct 6, 2015)

Being Devil's Advocate here:  How would 95% of T2s possibly know if they're 4 or 14?

Similarly, with a normo-glaycaemia range quoted by the same consultant in the same conversation as 3-6.5, what should non-diabetics do when 3 can be perfectly normal for them?  Would they ever know what their blood score was?

Just to add, I would never drive if I felt unwell, or had any Hypo symptoms, irrespective of blood score.


----------



## Andy HB (Oct 6, 2015)

AndBreathe said:


> ...
> I guess I'm just sensitive to having observed many T2s, getting their bloods into order, finding themselves under 4, but feeling fine, having a decent old panic and heading straight to glucose tablets, when what is actually happening is their body is just beginning to perform as it should.  ....



No argument from me on that point, no-one should panic at all, especially if they feel fine. 

But if they are shakey and sweaty and not feeling well and are below 4 when they test, then a quick remedy is definitely called for.

But, again it depends on the context. For me, I always had time to sort myself out because I was only on gliclazide for a short time and then on metformin (the latter doesn't really cause quick hypos, if it does at all). But if I was still on gliclazide, it would have been better to be safe than sorry. If I was already under 4, I could have gone yet lower and then possibly been unable to sort the situation out by myself (an issue because I lived on my own).

Andy


----------



## Rosiecarmel (Oct 6, 2015)

Ted Hayman said:


> Sailing in strange waters, without a chart or a compass!
> Why have I said the above? Because that's exactly how I feel right now!
> Diagnosed T2 last month, cast adrift with very little information apart from a recommendation from the doctor I saw to make use of the www.diabetes.org.uk website.
> Had to make my own appointment to see a specialist diabetes nurse who, it turns out, was nothing of the sort!
> ...



That's what happened to me as soon as I was diagnosed! Don't let them Palm you off with rubbish excuses. I'm T2 and was only diagnosed just over 2 months ago. I went back again, and again and came out with a meter to test myself. Was told to do it on a morning and after my biggest meal of the day (and if i eat "bad" foods so I can actually SEE what it's doing to my BS on the meter). Then I went back as the tablets haven't worked and I'm back again today for more bloods and new meds. 

I think they expected me to just go away and sort it out on my own and wait for another hba1c in 3 months time like you, but I didn't. This forum actually helped me realise that I NEED to go back for my health. If you need any help or any information, keep going back until someone listens to you. The (nice) nurse I saw the second time has referred me to a dietician as well for added help. Keep going back and demanding answers!

Personally I think being given a meter was one of the best things the nurse did for me. I am now able to start to understand what foods have the word effects on me therefore am able to try cut them down. I felt so confused and was told to "admit how much I eat then stop" (exact words from a nurse) it's taking a while but it's still early days and I feel i won't have to test for the rest of my life once I have a good understanding of foods that affect me personally as everybody is different


----------



## AndBreathe (Oct 6, 2015)

Andy HB said:


> No argument from me on that point, no-one should panic at all, especially if they feel fine.
> 
> But if they are shakey and sweaty and not feeling well and are below 4 when they test, then a quick remedy is definitely called for.
> 
> ...



To be clear Andy, if your initial post had included the information about Gliclazide, I wouldn't have said anything.  For anyone on Gliclazide or similar drugs, or insulin, the vigilance at lower levels is a much higher requirement for either treatment of any resultant lows, and/or working towards adjusting  meds or diet, where hypos are frequent or regular


----------



## Andy HB (Oct 6, 2015)

AndBreathe said:


> Being Devil's Advocate here:  How would 95% of T2s possibly know if they're 4 or 14?



Well, that is the point of this thread! Most won't because they can't test. 



> Similarly, with a normo-glaycaemia range quoted by the same consultant in the same conversation as 3-6.5, what should non-diabetics do when 3 can be perfectly normal for them?  Would they ever know what their blood score was?



Agreed. Who's to say what 'normal' is? I don't know the scientific basis for selecting 4 as the lower limit, but as I said before, if a lower limit has to be defined, then 4 is as good as anything.

All I know is that setting ranges and lower/upper limits was useful for me getting some control of my levels overall. If there were no guidelines at all, I would have been none-the-wiser about what to do.

Andy


----------



## Ted Hayman (Oct 6, 2015)

I have read this topic with considerable interest and opinions suggested to me that I needed to look into the subject of self monitoring/testing for T2 diabetics.
This I have done by trawling through the NICE document about diabetes, which says the following; "R22 Offer self-monitoring of plasma glucose to a person newly diagnosed with Type 2 diabetes only as an integral part of his or her self-management education. Discuss its purpose and agree how it should be interpreted and acted upon."
Now that seems pretty clear to me that I should be given the ability to self test as a means by which I can ensure that what I'm doing is the correct thing both in diet, exercise and using the prescribed medication. 
I found further evidence in a paper written by a American doctor, who stated that any diabetic (T2) prescribed Metformin, should be provided with the means to self test!

My conclusions from this? My surgery doesn't have a bloody clue!

Oh, I should add, my wife, who is a ex nurse seems to believe I'm taking this all too seriously! The epitome of medical conceit!!


----------



## AndBreathe (Oct 6, 2015)

Andy HB said:


> Well, that is the point of this thread! Most won't because they can't test.
> 
> 
> 
> ...



Sorry Andy, the first quote you responded there was meant to have been tagged to Matt's post, to point out the absurdity of the whole shambles of T2 care.

Please don't anybody get me wrong, I respect my GP and have worked with her to help her understand our condition, and indeed the whole metabolic syndrome better.  She has stated clearly that she initially felt unable to get her head around my approach to lipids, due to her admittedly superficial training.  We had some pretty "special" chats where she took more notes than me, but I'm fine with that.  I'm fortunate to have the intellect to be able to understand all these things, coupled with the time to do my research; it's a combination I doubt she can muster (meaning the time!) given the demands of her job, all the other "epidemic chronic conditions" she must encounter daily, and the rest of her life.  At least we have frank and honest discussions these days.


----------



## happydog (Oct 6, 2015)

Have only just caught up with this as we have had another family bereavement.  When I was diagnosed in September 2012 my level was 18.5 and the GP painted a really bleak picture of the future and said you will be on insulin soon and can expect your life expectancy to be decreased by at leas 10 years.  When I asked about the complications he said they were more or less inevitable as it is a progressive disorder with no cure.  He wanted me to go straight onto metformin and take statins.  I refused both and asked if I could try diet and exercise.  He dismissed the idea because he said it does not work and you will do further damage to your health while you "mess about".  I stuck to my guns weathered the family's disapproval and changed my diet, did more exercise and started testing.  He refused strips and the DN said it only makes people obsessive.  Slowly after much persuasion I am allowed 50 strips every two months. My experience has been that without the testing I would not know what spikes my BG and could not make informed choices about food etc.  I keep a record of my numbers and the effect of new foods.  DN and Dr are not interested and don't want to see these.  Their response is that it is most unusual for D&E to work but that it won't last.  I do not think that testing is for everyone, but I do think that they should be given the opportunity if they want to do it.  Most of my knowledge has come from this forum and I have had so much kind and willingly given  help and support that I will always be grateful.  I don't know what the future holds but I have had three years of healthy life so far.  My HbA1c reading is now 36 which is about 5.4.  Thank you everyone who has helped me.    I recommend that T2's test.


----------



## Amigo (Oct 6, 2015)

Oh my happydog....I found myself grimacing in angry disbelief at the utter stupidity displayed by your GP. When did he train? 1910? 

My GP simply gave me the meter and told me he was confident I could sort it. No, 'the end of the world is nigh' scenarios just the means to test and the belief it was 'sortable'. And of course it is because you are testimony to that. 
I wish these clueless medics would consider occupations that don't involve inflicting their inertia and ignorant medical pessimism on actual people!


----------



## trophywench (Oct 6, 2015)

Why why why do they take this attitude with T2 (you're gonna die anyway, so don't even bother trying not to!) and then NAG you (almost  to death LOL) unremittingly about your eg cholesterol level or smoking etc BECAUSE apparently - they  will kill you?


----------



## Northerner (Oct 6, 2015)

trophywench said:


> Why why why do they take this attitude with T2 (you're gonna die anyway, so don't even bother trying not to!) and then NAG you (almost  to death LOL) unremittingly about your eg cholesterol level or smoking etc BECAUSE apparently - they  will kill you?



They don't realise they are doing it, do they? 

No healthcare professional should present such a pessimistic view of the future to a patient. Even if it's something terminal, you would try to soften the diagnosis, anything else suggests you do not regard the person as a human being 

When I told a GPSI (GP with Special Interest in diabetes) that I had been able to stop my lantus, rather than finding it interesting and expressing hope it would continue for as long as possible, he simply sneered that I would soon be back on it. That was 3.5 years ago


----------



## Ted Hayman (Oct 9, 2015)

Interesting day at the surgery, although, probably for the wrong reasons!
My wife came to the surgery with me (bad mistake on her part) who then spent most of the hour  waiting which was fifty minutes longer than it should have been, complaining about the wait.

This of course, did not do much for my mood, which did not improve when I finally did get to see the doctor, who it appeared, was not too familiar with diabetes, its treatment or self testing.
Things did not improve when I explained why I was there and what I wanted (to self test). He excused himself, explaining that he needed to speak to someone else about this. At this point, I decided that unbeknown to us, aliens had finally taken over!

Two minutes later he returned with a nurse in tow who, having been told what I wanted then explained all this to the doctor, who finally got the message................I think!

Anyway, it seems that if I get the meter of my choice, I then give them the product codes for the strips and the lancets, they will give me the appropriate prescriptions for them.

So, which meter?


----------



## Ted Hayman (Oct 14, 2015)

A further twist in my desire to self test occurred on the Saturday afternoon I had my flu jab at Boots. My wife, for reasons best known to herself, decided to engage the pharmacist in a conversation regarding my self testing.
I didn't take part in this conversation, it was pointless, as my decision had been made and acted upon, but, I still had to sit and politely listen and be told that as I was borderline there was no need for me to self test, that is was painful and messy!
Once outside, I said to my wife that opinions were like anuses (I used a word equally descriptive, but ruder) everybody's got one! 
Personally, I think it's my wife who needs educating about diabetes, rather than me!


----------



## Northerner (Oct 14, 2015)

Ted Hayman said:


> A further twist in my desire to self test occurred on the Saturday afternoon I had my flu jab at Boots. My wife, for reasons best known to herself, decided to engage the pharmacist in a conversation regarding my self testing.
> I didn't take part in this conversation, it was pointless, as my decision had been made and acted upon, but, I still had to sit and politely listen and be told that as I was borderline there was no need for me to self test, that is was painful and messy!
> Once outside, I said to my wife that opinions were like anuses (I used a word equally descriptive, but ruder) everybody's got one!
> Personally, I think it's my wife who needs educating about diabetes, rather than me!



Well, it's not really painful, nor is it messy - I've done approximately 20,000 tests since diagnosis and only a very small fraction actually made me go OW!!! And maybe one or two ended up with me getting a bit of blood on something, but I would say that in the last 7.5 years sneezing has probably caused greater discomfort and mess   The fact that you are borderline is what makes testing so useful - being able to remove or reduce those items in your diet that cause the greatest problems should bring your levels the right side of 'borderline', and should also mean you can minimise your testing in future, knowing what things to avoid. 

Great that your GP is prescribing strips for you! You need the PIP code for the strips, although the surgery ought to have them on their database anyway


----------



## Ted Hayman (Oct 22, 2015)

Took delivery of my tester today (Contour XT). Now just need to set it up and learn how to use it properly!


----------



## Northerner (Oct 23, 2015)

Ted Hayman said:


> Took delivery of my tester today (Contour XT). Now just need to set it up and learn how to use it properly!


When procking your fingers remember to use the side of the pad, not the front as there are more nerve endings at the front, meaning it will hurt more. Rotate your fingers to allow them to heal and avoid using your index finger and thumb. After pricking wait a couple of seconds before giving a gentle squeeze to get the blood drop - the initial reaction when pricking the finger is for the wound to try and close, but a couple of seconds will relax it and make it easier to get the blood. Make sure your fingers are clean, but don't use alcohol wipes as these could skew the result. Warm fingers will give blood more easily than cold, so if you have problems running them under warm water for a few seconds will help.

Good luck Ted, let us know how things go!


----------



## BigMalc (Oct 23, 2015)

I have obviously been lucky with my GP practice.  On diagnosis about 10 yrs ago now (wow how has it been that long) the Doc spelt out a few home truths, talked exercise and portion control etc, then over the course of the next few months I had 3 or 4 visits back testing and checking all sorts of things whilst the DSN kept adding extra bits of info in to the mix, to include a meter after a couple of visits.  This meant I wasn't panicking about data overload at the start and could process it steadily and learn bit by bit.
I also have a v good unit at the hospital for annual checks and more specialist advice and despite the progressive nature of it (on insulin now) have never had an issue with getting strips as all local to me are v keen for me to be active (or should I say responsible) in managing my condition.
Testing should be mandatory for all medicated T2s and possibly all T2s, even if only for a week a month just to keep a regular eye on things.  I now know pretty much what my readings will be before testing based on how I feel, what I have eaten etc so wouldn't test 6/7 times a day anymore if DVLA didn't insist on it, but would abs still test regularly to keep in overall check.


----------



## Northerner (Oct 23, 2015)

Just how it should be for everyone Malc, if your healthcare team can do it then there's no excuse why others can't. I beleive in business it's known as 'best practice' - there should not be such a gulf of variation in the way people are treated!


----------



## Ted Hayman (Oct 23, 2015)

Thank you Northerner for the tips on testing. When I saw the Practice Nurse for a rash I had, knowing I was T2 diabetic, she suggested doing a test to which I agreed. I then sat and watched exactly what she did so, I had a practical demonstration of the process!
I'll keep you posted.
Between now and the middle of December, life is going be a little hectic, we're moving from South Yorkshire to East Sussex! When selecting a new surgery, I'll look for one with a well established diabetic clinic!


----------



## Ted Hayman (Oct 27, 2015)

Finally! Did my first test this morning an hour (probably was longer) after breakfast. First attempt not a great success, I think I may have discovered I have lazy blood (joke) drop not big enough to give a reading, second attempt much better, sufficient blood and got a reading of 8.8. As an aside; I took the necessary coding for lancets and test strips to the surgery early last week, so I could get these on prescription, checked on line today, nothing, nada, zilch so, it looks like I need to go and rattle a cage there!


----------



## Northerner (Oct 28, 2015)

Ted Hayman said:


> Finally! Did my first test this morning an hour (probably was longer) after breakfast. First attempt not a great success, I think I may have discovered I have lazy blood (joke) drop not big enough to give a reading, second attempt much better, sufficient blood and got a reading of 8.8. As an aside; I took the necessary coding for lancets and test strips to the surgery early last week, so I could get these on prescription, checked on line today, nothing, nada, zilch so, it looks like I need to go and rattle a cage there!


Good luck in getting that prescription Ted! Nothing more infuriating than the 'insufficient blood' error!  Some meters allow you to try again on the same strip, others force you to use a new strip


----------



## Ted Hayman (Oct 29, 2015)

Got prescription after going back to the surgery, took it to the nearest chemist, handed it in, they then told me they hadn't got the lancets but, they would order them and have them in the next day (today). Went back this afternoon (Thursday) only to be told that the order had not arrived but was expected tomorrow. I said I couldn't come back tomorrow, so, I asked for my prescription back and said I'd go elsewhere, elsewhere being Boots.
I now have a full supply of test strips and lancets but, what a performance to get them!


----------

