The Diabetic Handyman (Continued)
No free market in a monopoly
What about market pressures, you may wonder? Surely if brand "X" is much worse than brand "A," word will get around and no one will buy brand "X," and they will be gone in no time. In any economic arena other than healthcare, this would probably be true. But for most Americans, there's no choice when it comes to blood sugar meters. Despite the dazzling array of options, most patients are stuck with the meter their health insurance company chooses for them. And how do our health plans choose the meter that is best for us? Do they study the features that could benefit us? Do they consider accuracy? Or reliability? Hell no. They choose the one that's cheapest. Whichever meter company can cut the plan the best deal gets the contract, and that's the meter you're stuck with.
What can you do if you have a crappy meter? Well, for one, make a fuss. Complain to your plan, to your Senators and Congressmen, and to your state corporation commission. Ask your doc to do the same. They say there's power in numbers and the latest estimate is that there are 27,000,000 of us with diabetes in this country. That's a pretty powerful number. If someone wants to make a bumper sticker that says "I have diabetes and I vote," I will happily put one on my Jeep.
Making the best of a bad situation
In the short term, if you can get enough strips (a related, but separate problem), you can always take two tests and average the results before taking your meds. Historically, health plans would only cover one strip per day for persons with diabetes on oral medications and three a day for persons with diabetes who use any kind of insulin. This may change as the latest treatment guidelines from the American Diabetes Association made it very clear that the 1-3 strips a day is not enough.
Speaking of enough strips, how often and when should a diabetic test blood sugar? It depends on type of diabetes you have, how good or bad your control is, and what meds you take. But let's play a game. If I told you your blood sugar a couple of hours after a meal was 358 mg/dL, what could you tell me about that meal?
You can't tell me anything about the meal. For all you know, your blood sugar was 400 before the meal and the meal actually treated you pretty well!
My point? A single number is worthless. You need context. You need pairs. You need to test before and after something to understand what that something does to your blood sugar. Something can be eating, exercise, or sleep. If you want to know how a meal treats your diabetes and your diabetes medications, you need to test before you eat and two hours later. Don't look at the numbers, per se, but look at the difference in the numbers. Likewise, you could study how a workout affected your blood sugar. Or test at bedtime and the next morning to see what effect your sleep patterns have on your blood sugar.
This is the foundation I was talking about. The meter and strips are your tools, but you use them to build a strong, stable, solid foundation for your diabetes home improvement project. The foundation of diabetes is understanding how all the various elements of your life interact with your diabetes and your diabetes medication(s).
Build your foundation by understanding how various foods, activities, stresses affect your blood sugar numbers, then take action based on what you learn.
How many sacks of concrete does a good foundation need? What's the best number of blood sugar tests for diabetes? As many as you can do. In a perfect world, you'd have enough strips to test all your meals, all your activity, all your nights of sleep. Of course in a perfect world I would have been able to assemble that tricycle that Santa brought my kid for Christmas.
In the absence of enough good strips, we have to use what we do have cleverly. If you only get one a day, test before and after something every-other-day. So while you are still in the process of advocating for good tools, and enough of them, build the best foundation you can.
Right now my blood sugar is pretty good, so I'm off to fix that squeaky bathroom door. Now where did I leave my power screwdriver?
Wil Dubois is the author of four multi-award-winning books about diabetes. He is a PWD type 1, and is the diabetes coordinator for a rural non-profit clinic. Visit his blog, LifeAfterDX.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from