Value of Blood Glucose Self-Monitoring

In the 1960s, Richard Bernstein, an engineer and a Type 1 diabetic, pioneered the use of blood glucose self-monitoring. Using it, he was able to greatly improve his glucose control and thereby his health. No one doubts it helps Type 1 diabetics. With Type 2 diabetics, whose blood glucose is better controlled, the benefit is obviously less clear — but to many Type 2 diabetics, unmistakable.

A recent literature review, however, begged to differ:

Contrary to the widely-held belief, there is no proof that non-insulin-dependent patients with type 2 diabetes benefit from glucose self-monitoring. Moreover, it remains unclear whether an additional benefit is displayed by the blood test compared to the urine test or vice versa, in other words, whether one or other of the tests might offer an advantage to patients. The current data are quantitatively and qualitatively inadequate: the few trials that are suitable for investigating these questions have not included or have insufficiently reported many outcomes important to patients. Owing to their short duration, it is also not possible to draw any conclusions on the long-term benefit of glucose self-monitoring. This is the conclusion of the final report of the Institute for Quality and Efficiency in Health Care (IQWiG), [which is in Germany,] published on 14 December 2009.

Which is even more ridiculous than dermatologists concluding that acne isn’t due to diet. At a forum for diabetics, the report was roundly criticized:

Telling a Type 2 Diabetic not to measure his/her BG is like telling an overweight person not to weigh themselves…Ignorance is NOT bliss.

Totally agree! I was told by a nurse the other week not to measure my blood pressure at home as ‘home testing can cause patients to get worried”!!!

I have recently been diagnosed with type 2, and without the regular testing i did whilst i was going though my diet change, I would have no idea which foods caused high or low readings. I definitely think regular testing gives you the ability to control your diabetes 100% more than with no testing and using the 3 month HBA1c tests.

[impressive self-experimentation:] For my own edification, I discovered that chromium, zinc, and vitamin B1 added to my diet were benficial. I discovered that cinnamon, selenium, Omega 3, and some other quack remedies being touted on the web did nothing for me except empty my pocket. I was about to start investigating CQ10 enzymes, but the doctor [who said "don't self-test"] stopped that trial in its tracks.

The most noticeable thing about this thread is how many people have either just joined or made a relatively “early” post after belonging for ages. Amazing! There is a depth of feeling aroused [by this report] that wasn’t apparent before!

Why have dermatologists claimed we can’t say acne is caused by diet (“there is insufficient evidence”)? Why did these diabetes researchers claim we can’t say home testing helps Type 2 diabetics? A big reason, I believe, is that these claims (if true, which they aren’t) would preserve their gatekeeper function. You don’t need to see a dermatologist to stop eating chocolate. Home testing will reveal all sorts of simple ways that you can control your blood sugar without medicine. The doctors who reach these ridiculous conclusions have a big conflict of interest that goes unstated. They are fine with the conclusion that home testing helps Type 1 diabetics because Type 1s will still need them. Because Type 1 diabetics inject insulin, they need doctors to prescribe it.

7 Responses to “Value of Blood Glucose Self-Monitoring”

  1. Hypatia Says:

    Seth,
    While I usually agree with you, I am finding myself less convinced by your gatekeeper theory. Type II diabetics, even if their blood sugar is well controlled, have to see their doctors on a regular basis to monitor their liver and kidney function.

    But I look forward to hearing your thoughts.
    Hypatia

  2. Jim Says:

    Blood glucose testing, or urine testing? For me, either could work, and it just becomes a matter of convenience and personal preference. Of those two choices, I prefer blood glucose testing.

    However, I very much prefer an entirely different measurement: my pulse rate.

    A fingertip pulse oximeter shows how my body is responding to food, with results much quicker than either blood or urine tests.

    And as someone who has both Type 2 diabetes and frequent chest pains, I like to monitor both conditions.

    The pulse oximeter results vary from the blood or urine tests, because I get very rapid heartbeat (tachycardia) from bread and cereals (gluten?). Also, my pulse is affected is very strongly coffee and tea. Generally speaking, my blood glucose and my pulse rate move in the same directions, with some differences

    But those differences are important, and my pulse oximeter has helped me identify and avoid foods that cause me to have very unpleasant tachycardia and chest pains.

    A fingertip pulse oximeter is expensive, but no testing supplies are needed. A cheaper alternative for measuring pulse would be an ordinary blood pressure monitor.

  3. seth Says:

    Hypatia, long before they resisted home testing for Type 2 diabetics, doctors resisted home testing for anyone. And it isn’t just these two examples — acne and diabetes. Prevention is generally ignored. What’s your explanation for why prevention is so ignored by American health care?

  4. Alex Chernavsky Says:

    This essay argues that preventive medicine isn’t cost-effective:

    http://www.nytimes.com/2008/10/07/health/views/07essa.html

  5. Jim Says:

    Seth, you asked Hypatia why prevention is ignored, but I’ll give my answer also.

    I think doctors neglect prevention for two reasons:

    1. Doctors think that patients will be more likely to do something simple like taking pills, instead of making major lifestyle changes, even though lifestyle is much safer and effective than pills.

    2. Doctors get reimbursed for doing something. And while prescriptions are a tangible action, just counseling patients about lifestyle may not be considered important or effective in the eyes of the insurers.

    Health care reform will be meaningless if the only changes are in who pays for drugs and surgeries. The real change will only occur when doctors are rewarded financially for teaching patients how to modify their lifestyles.

  6. Cord Says:

    I don’t think it’s necessarily a Gatekeeper attitude that causes this. I do think that people who have finished several years of expensive specialized education often become a little cynical about the intelligence of the public, and are unable to view patients as individuals: all recommendations must be suitable for “the public” and “the public” is stupid, and if you make a recommendation for someone intelligent and curious, you are in danger of having your recommendation followed badly by this great theoretical dumb mass of “the public”. So if it can’t be used by a cow, it’s not valid.

  7. Nancy Says:

    Found this commentary rather interesting as a (probably) LADA diabetic, who was first diagnosed as Type 2 before the right docs looked at the tests and saw Type 1. I think home blood glucose testing (by the time the sugar’s in your urine, you’ve been high for TOO long) can be equally as beneficial to Type 2s IF they are taught how to respond to the numbers on the little gadget and how to log and look for patterns. The idea is to prevent as much long-term damage as possible and improve daily quality of life, right? Really, I think well-trained diabetes educators (or similar educators for other conditions) can be just as beneficial to ANY person with diabetes as doctors.

    And, in response to Jim above – tachycardia is not really going to tell you which direction your blood glucose is heading. Your pulse can accelerate if your sugar is crashing, too. Believe me – I have mistaken that sensation of increased heart rate for increasing BG levels as well, until I get out the meter and do a fingerstick.