A common question I hear is do I have to check my blood sugar? Many patients dislike pricking their fingers. They find it painful and will usually forget to check. They do not carry their glucometer with them, don’t want people to look at them differently and feel it just takes time they don’t have. Most don’t understand the reason for checking other than to tell their doctor that they checked.
So, Do I have to Check my blood Sugar?
A study concluded that for patients with type 2 Diabetes that don’t inject insulin it is not necessary to check blood sugars. The article appeared in JAMA Internal Medicine. The objective of the study was to look at hemoglobin A1C levels and health-related quality of life. They looked at three groups: no testing group, once per day testing group and once per day testing with feedback. The results were no significant difference in the three groups. The authors concluded that regular testing of the blood sugar by patients with non-insulin type 2 diabetes is not necessary. (Here is the citation for the study: Young, L et al. “Glucose Self-monitoring in Non–Insulin-Treated Patients with Type 2 Diabetes in Primary Care Settings: A Randomized Trial”, JAMA Intern Med. 2017;177(7):920-929).
The question is: To Check or Not to Check Blood Sugars?
For patients on insulin the answer is that we always recommend checking blood sugars. But for patients on only oral medications, there is an ongoing debate about the benefits of checking blood sugars. There are Health Systems and insurances that limit quantity of testing supplies due to high cost. Many practitioners do not see the need or benefit for patients to monitor unless they are on insulin.
Many insurances like Medicare B will cover strips for patients with diabetes on oral medications but just one strip per day. Choosing carefully when to ask patients to test becomes very important to get the most information to improve treatment.
When seeing patients especially those with very high A1C, checking blood sugars can help improve therapy without waiting three months. While an A1C can give us a lot of information, it cannot give us detail information such as how high blood sugars are going in the morning or after meals. I often ask patients to check fasting blood sugars first in the morning and work on controlling these sugars first. Once the morning fasting blood sugars are under control, I will ask to ROTATE time of finger stick check (before meals, after a meal, at bedtime) over the course of 1-2 weeks. This allows reducing testing frequency while allowing me to see patterns over time. Once blood sugars are better control frequency and number f blood sugar checks can be decreased or even stopped.
Why Test?
Patients can use the information they get from the test to improve their blood sugars. Testing for the sake of testing does no one any good. For the patient:
- testing can help see what certain foods do to their blood sugars.
- What things can help like exercise or make the blood sugars worst like sodas.
- Can also help the patient decide as to when to call their doctor.
This is all part of learning self-monitor of blood sugar (SMBG) or how to manage your blood sugars.
Data shows that in type 1 diabetes, patients who test tend to have a lower A1C and a lower number of acute complications. Data also shows that patients who do SMBG have better control regardless of treatment or type of diabetes.
Other reasons why to consider checking blood sugars:
- it can emphasize the importance of medication adherence for the patient.
- Checking blood sugars is very important for patients using insulin. Learning how to use the glucometer, insulin injection techniques, storage, and when to inject tend to be too much to spring on a patient all at once. Introducing the concepts more gradually may help them adopt the information easier and not feel overwhelmed.
When to Check
- Before and after exercise: can help prevent low blood sugars and it can show the patient the benefits of exercise in lowering blood sugars.
- Before and after meals: to determine insulin to carb ratios, dosing of meal time insulin, effects of foods or portion size on blood sugars.
- Illnesses: patients should check more frequent when they are sick, patients should be instructed and develop a sick day plan.
- Pregnancy: will need to check more frequent before, after meals and before bedtime; to avoid complications for the unborn baby.
What if I don’t want to check Blood Sugars?
Sometimes patients have reasons they don’t want to check, it could be because they don’t see the need for checking blood sugars, they dislike needles, checking hurts, they don’t want to check when they are outside the house, they work overnight, they don’t want to see high blood sugars or financially, checking can be a burden. Education can help, you need to know where you are in order to know where to go. You need to check in to see if you are heading in the right direction.
Patients who “fall off the wagon” and glycemic control worsens is usually because they stop testing, taking their medications and managing their diabetes. If you don’t know how high your blood sugars are going, you can not do anything about it. For these patients not being motivated has a lot to do with it. Sometimes patients are depressed, ashamed of not being able to manage their blood sugars, have social barriers such as financial barriers, homelessness, job loss and food insecurities.
CGM (Continuous Glucose Monitors)
New technology has brought freedom from finger sticks. The information CGM provides is instantaneous and can allow patients to see in real time what different foods do to their blood sugars. CGMs also provide an abundance of data to the provider which allows them to make more accurate interventions that will help bring down the blood sugars.
Summary
I believe that checking blood sugar is a very good tool when used correctly. Can help patients and their Doctors manage blood sugars better. To the question to check or not check? It is an individual decision you should make with the help of your Doctor or diabetes educator. For some patients checking their blood sugars becomes a source of stress, for these patients is probably better not to check if they are not using insulin. Understand the benefits to checking and why do it before you decide you will not.