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  #1   ^
Old Thu, Dec-13-18, 09:44
teaser's Avatar
teaser teaser is offline
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Plan: mostly milkfat
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Default Testing blood glucose too often?

https://www.sciencedaily.com/releas...81210144946.htm

Quote:
Millions of low-risk people with diabetes may be testing their blood sugar too often

For people with Type 2 diabetes, the task of testing their blood sugar with a fingertip prick and a drop of blood on a special strip of paper becomes part of everyday life.

But a new study suggests that some of them test more often than they need to.

In fact, the research shows, 14 percent of people with Type 2 diabetes who don't require insulin are buying enough test strips to test their blood sugar two or more times a day -- when they don't need to test nearly that frequently according to medical guidelines.

That's costing them time -- and sometimes worry -- while their insurance plans pay hundreds of dollars a year for their supplies. Multiplied over the millions of Americans who have Type 2 diabetes, the findings could mean millions of unneeded blood sugar tests and millions of dollars spent for no good reason.

The study, published in JAMA Internal Medicine by a team from the University of Michigan, focuses on the subset of people with Type 2 diabetes who research has shown don't get a benefit from daily tracking of blood sugar levels. This includes both patients who don't take any medicines to reduce their blood sugar, and those who take oral medicines that don't require monitoring.

In fact, three different medical societies -- the American Academy of Family Physicians, the Society of General Internal Medicine and the Endocrine Society -- have all issued guidance for physicians stating that such patients don't need to regularly test their sugar levels.

The study didn't include patients who clearly need daily monitoring: those who need to inject insulin and those who take medications that carry a risk of causing too-low blood sugar levels.

Notebooks full of numbers

Kevin Platt, M.D., the internal medicine resident who led the analysis of insurance data from 370,740 people with Type 2 diabetes, cautions that every patient is different, and no one should stop testing their blood sugar without first talking with their physician.

Platt, who sees patients in the General Medicine clinic at Michigan Medicine, U-M's academic medical center, started the study after noting that some of his patients would come to clinic with notebooks filled with multiple daily blood sugar levels that they'd carefully kept for years.

Such logs might help a patient feel in control of their condition, he notes. But they have no clinical value for physicians if the patient is stable on their medications or lifestyle adjustments, and isn't on insulin or a type of diabetes medication that carries a risk of hypoglycemia.

Patients who only take metformin -- the most commonly prescribed blood sugar lowering medication -- don't have this risk. So most don't need to test at all, much less multiple times daily.

The national professional society statements about daily testing are based on years of research. They're part of the Choosing Wisely initiative led by physician groups that has identified tests and treatments that may be used too often.

How the study was done

Platt and senior author A. Mark Fendrick, M.D., a professor in General Medicine, decided to look at information from a national insurance database made available through U-M's Institute for Healthcare Policy and Innovation, of which Fendrick is a member.

They focused on data from after the Endocrine Society and Society of General Internal Medicine issued their guidelines to reduce inappropriate home testing in 2013 -- and looked at patterns of test-strip prescription fills over one year of each patient's records.

The study included patients with private insurance -- whether obtained through a job or through Medicare Advantage plans that cover about a third of people over age 65.

They only studied Type 2 diabetes patients who were not taking insulin, and who filled prescriptions for packets of 90 test strips three or more times a year, suggesting that they were testing their blood sugar regularly. They also looked at data from patients who didn't fill any test strip prescriptions.

In all, 23 percent of the study population -- 86,747 people -- filled test strip prescriptions three or more times. But more than 20 percent of this subset didn't fill any prescriptions for diabetes medications medicine at all -- and another 43 percent filled prescriptions only for metformin or other medicines that didn't carry a risk of hypoglycemia. After the patient has found the dose of these medications needed to keep their sugar levels stable, they don't need to do daily testing.

But even though these two groups of patients didn't need to be testing daily, they were using an average of two test strips a day.

Costly implications

Test strips didn't cost the patients in the study very much -- about $18 a year in co-pays, on average. But for their insurance plans, the annual average total cost was about $325.

"One of my patients who didn't need to be testing daily told me that her previous doctor had told her to test his sugars two or three times a day," says Platt. "These data show that over-testing is quite common -- and with the appropriate guidance can be reduced significantly."

Patients who don't have insurance coverage for their test strips are likely paying much more out of their own pockets, he notes -- and the study didn't look at the cost of the lancets needed to prick the skin to obtain the drops of blood needed to test.

Platt and Fendrick note that even if they don't have to test multiple times daily, or once a day, some people with Type 2 diabetes may choose to do so in order to "know their numbers" and keep tabs on how their diet, exercise and any medicine are affecting their sugar levels.

But for those who are testing daily, and don't have to be, their providers should tell them they have the option to stop and offer more helpful tests that tell patients their average blood sugar level over the past 2 to 3 months.

"Health care costs and access to care are an important issue for many Americans," says Fendrick. "The savings that result from reducing the use of unnecessary care -- such as needless home blood sugar testing -- can create 'headroom' to spend more on those clinical services that we need to buy more often."



What a load of crap. Patients testing "too" often interferes with physicians plans to put some of their patients on metformin autopilot. The sort of feedback people get from multiple day readings is empowering. It's wonderful feedback to tell a patient whether a dietary program meant to keep blood sugar in check is in fact doing so. Also a great way to expose the stupidity of the diet plans most advocated for diabetes.
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  #2   ^
Old Thu, Dec-13-18, 10:18
khrussva's Avatar
khrussva khrussva is offline
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Plan: My own - < 30 net carbs
Stats: 440/209/210 Male 5' 11"
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Quote:
The sort of feedback people get from multiple day readings is empowering.

You got that right. Learning how different foods - even low carb options - was a extremely helpful to me. I was able to craft a diet that minimized BG spikes. That resulted in less craving, longer satiety between meals, continued weight loss, and eventually regaining insulin sensitivity. To get that BG data I was pricking my finger 5 to 10 times per day doing postprandial readings in 30 minute increments after many, many meals. I did that for several months. I used every finger. At one point they all looked like pin cushions. Admittedly, I was probably a little OCD about it there for a while.


I learned what I needed to know, though. It was painful at times, but it was worth it. I rarely test my BG now - 2 or 3 times per month just to make sure I'm still good. I am. I still make decisions about how I eat based on what learned from frequent BG testing. Heaven forbid that I know more about proper diabetic nutrition than the doctors do.
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  #3   ^
Old Thu, Dec-13-18, 12:43
s93uv3h s93uv3h is offline
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Plan: Atkins & IF / TRE
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My wife stopped metformin more than a month ago (on her own), and still tests daily. As her n=1, after cutting carbs ( rice ) significantly, though not completely, her reading this morning, (after eating a little bit) was 81. Gave her a fist bump. Of course her A1C dropped from 6.7 to 6.4 to the latest 6.1. Type 2 reversed.

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  #4   ^
Old Fri, Dec-14-18, 05:53
JEY100's Avatar
JEY100 JEY100 is offline
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Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
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Progress: 96%
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s93...Great news about your wife's A1c!

$17.62 for 100 strips, not using insurance. https://www.adwdiabetes.com/product...test-strips-100 If it costs the insurance company $325 that is their fault.

It is becoming more common that generic drugs cost less using the store's direct price than running through our medicare drug plan. DH has a prescription skin cream and sleep aid, the Target/CVS price is cheaper than the co-pay.
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  #5   ^
Old Fri, Dec-14-18, 11:08
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Ms Arielle Ms Arielle is offline
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Plan: atkins
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s9--- Hurray for your wife's progress!!!

Im all for testing blodd sugars. A device is on my Christmas list. It it the ONLY item listed!
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  #6   ^
Old Fri, Dec-14-18, 19:59
PaCarolSue PaCarolSue is offline
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Plan: Wheat Belly
Stats: 217/182/175 Female 5ft 2 inches
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Progress: 83%
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I have a Relion Meter from WalMart and their test strips are $17.88 per 100. My insurance will only pay for enough strips to test once a day and I am more comfortable checking more often.

An insulin dependent diabetic needs to test to be sure they are injecting the correct amount of insulin. "They" don't feel that those not on insulin need to test because there is nothing they can do about a high reading anyway, but it is a learning tool, learning what foods spike and which ones don't, as Ken said.
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  #7   ^
Old Fri, Dec-14-18, 21:55
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FREE2BEME FREE2BEME is offline
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Plan: Atkins & IF
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Iíve put a glucose meter and strips and lancet in my amazon cart multiple times, but always back down. I get all caught up in the details of whether itís the most reliable or whether the strips are too expensive to order online and such. But itís something Iíd like to do to determine how I react to certain foods. Maybe Iím just a big scaredy-cat. 😂
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  #8   ^
Old Sat, Dec-15-18, 03:50
JEY100's Avatar
JEY100 JEY100 is offline
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Plan: IF Fung/LC Westman/Primal
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Quote:
Originally Posted by FREE2BEME
Iíve put a glucose meter and strips and lancet in my amazon cart multiple times, but always back down. I get all caught up in the details of whether itís the most reliable or whether the strips are too expensive to order online and such. But itís something Iíd like to do to determine how I react to certain foods. Maybe Iím just a big scaredy-cat. 😂
. Ummm...you might find that 12g of Sugar in the form of lactose from that skim milk (per cup) does raise your glucose. You should be able to find a free meter deal and Sue and I are happy with the non big Pharma brands, all meters are tested to a certain standard of reliability, paying under $20 for 100 strips. .
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  #9   ^
Old Sat, Dec-15-18, 06:30
PaCarolSue PaCarolSue is offline
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Plan: Wheat Belly
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FREETOBEME, if you are not diabetic, your body works to control your blood sugar, releasing more insulin when needed and less when not and clearing blood sugar out in minimal time. It's only in diabetes that the body does not do this properly.

If you were to start testing as a non diabetic, I would recommend you look up and study what the blood sugar ranges should be for a non diabetic in different situations. Your blood sugar DOES go up after you eat, and your body regulates it back to normal in a reasonable amount of time. You would have to know what the ranges for that should be so as not to panic when you see it rise. The increases will be minimal with low carb eating, but will still be there to some degree.

It would be somewhat beneficial to test certain foods if you are eating them, such as fruit or starchy vegetables.

By law, meters are allowed to be off by 20% and are the results are only to be a guide.

If you went with Walmart's Relion, your initial outlay would be $10 for a meter and $9 for 50 strips, $18 for 100. You would probably be spending more on Amazon but not necessarily getting better results. And once you saw how your body is working, you really wouldn't need to continue testing.

If you are doing this because you are concerned that you might be diabetic or prediabetic, you could ask your doctor to do an A1c blood test to find out, but that would probably lead to meds if it proves to be positive.
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  #10   ^
Old Sat, Dec-15-18, 07:18
Ms Arielle's Avatar
Ms Arielle Ms Arielle is offline
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Plan: atkins
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In DANDR he goes into detail about the 5 levels , ending with full blown diabetes. Meaning there are steps along this pathway. I took him seriously and started to change my eating immediately as I had been a gestational diabetic.The was my wake up call.

I have a T1 friend, that wears a monior and a pump, and still finger pricks a few times a day. Mostly when a new pump is set up.

We had a member here who would check her sugars to test the effect of a specific food. Eating the same foods for several days, only changing one item like to strawberries or other fruit. Interesting to see not all fruit is the same.
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  #11   ^
Old Sat, Dec-15-18, 09:08
FREE2BEME's Avatar
FREE2BEME FREE2BEME is offline
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Plan: Atkins & IF
Stats: 260/194/150 Female 65 inches
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Progress: 60%
Location: Japan
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Quote:
Originally Posted by JEY100
. Ummm...you might find that 12g of Sugar in the form of lactose from that skim milk (per cup) does raise your glucose. You should be able to find a free meter deal and Sue and I are happy with the non big Pharma brands, all meters are tested to a certain standard of reliability, paying under $20 for 100 strips. .

I have no idea what youíre talking about... 😂 🤣😅 Who would be so silly as to derive ALL their carbs for the day from silly lattes? 😝

Iíve never heard of free meter deals and a lot of places donít want to ship to Japan. Iíve found some on eBay, but theyíre sketchy. And Walmart doesnít ship to Japan. Can you believe it?

In addition to the machine and strips, you also need a lancet and the replacements, right?

Last edited by FREE2BEME : Sat, Dec-15-18 at 09:17.
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  #12   ^
Old Sat, Dec-15-18, 09:15
FREE2BEME's Avatar
FREE2BEME FREE2BEME is offline
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Plan: Atkins & IF
Stats: 260/194/150 Female 65 inches
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Progress: 60%
Location: Japan
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Thank you, carol. I would need to educate myself on all that. I do a lot of IF and wonder if Iím letting my blood glucose get too high during my eating window. Two years ago, when I was nearly 260 pounds, I had my A1C tested and it was 4.9 or 4.8. Iíve lost just over 50 pounds since then, so I donít think Iím at risk for diabetes. I just want to know how my body responds to certain foods. My brother, mother, grandmother and various other immediate family members have diabetes or had gestational diabetes, so I know I need to stay vigilant. I discovered Atkins just before I started conceiving, so I never gained weight in my pregnancies and was often in ketosis during that time. Maybe I shouldnít bother, but I love data and research and anything that will convince me to stay on track has to be a good thing, I would think. 👍
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  #13   ^
Old Sat, Dec-15-18, 11:56
Ms Arielle's Avatar
Ms Arielle Ms Arielle is offline
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Plan: atkins
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Brandy, I am like you, and would like to get a better handle on my blood sugars. For some reason my A1c went up a lot, so figure the only way to better figure out how to manage blood sugar and insulin is a meter. Waiting for an A1c is too late to see if Im am making progress.
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  #14   ^
Old Sat, Dec-15-18, 21:32
PaCarolSue PaCarolSue is offline
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Posts: 502
 
Plan: Wheat Belly
Stats: 217/182/175 Female 5ft 2 inches
BF:lots/lots/less
Progress: 83%
Location: USA
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Brandy, there is nothing wrong with wanting the information about your blood sugars. It is good to want to pay attention to that. You had wonderful A1c. I am in the process of bringing mine down. It was 7.3. The last time it went down to 6.7 and now I'm working toward getting it at 6 or below.

Ms Airelle, My best friend had a hard time accepting that she had diabetes. At a general check-up she was told her A1c was 7.1. She refused medication and would not test. She said her mother used to complain about how bad her fingers hurt from testing so she won't do it. She was just watching the sugars in her food. Eventually her A1c went up to 8. She still refused meds and testing, but I told her she has to cut carbs as well as sugars so she kept lowering her carbs until she received an A1c of 6. Still doesn't test. Now she told me she's starting to eat sweets again. I could not stop testing. I have to know I have my blood sugar under control.

Things have changed so much with testing that my fingers don't get sore. If you test on the sides of your fingers instead of the pads, it is not as painful.
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  #15   ^
Old Sun, Dec-16-18, 04:49
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 11,148
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
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If you donít need a prescription for a meter in Japan, have you looked in the large chain drugstores for a meter kit. When I was deciding what to buy, read that there are two companies that make almost all the private labels in the US. Target, CVS, Walgreens brand meters come from the same factory making the True line.
There is an on-line diabetes supplier in Canada (TotalDiabetes) that ships international, more than the cost of the True Kit, but you know what reasonable international rates are.
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