Re: BG test frequency (was Good food? Bad food?)

[Guest guest]

> Then when you have a new food

> you want to see how it reacts,

> you test two hours after a meal

> - once - and then work out how

> to work it into the diet.

What do you mean by " a new food " ,

Melisma, and how do you " work it

into the diet " ?

The idea of " working a new food

into the diet " is a new one on me.

I cannot even remember seeing a

new food in years, everything is

pretty much the same as it has

always been around here!

> In my circumstances I try to test

> twice a day at the minimum -

> breakfast and at least one other

> meal, or just before bed. I feel

> most comfortable testing before

> all meals, tho', so I plan my strip

> purchases with three to four tests

> per day. I also test between meals

> if I suspect I'm having a low - and

> indeed, it's sometimes taken me

> four to six test/treat cycles, so

> I usually try to get more strips

> than I think I will use in a month,

> just in case.

OK, I don't know what your circum-

stances are but if you were a usual

NIDD type 2 isn't that a lot of tests,

4 a day? In Germany, the health

insurance normally pays for 100

strips a quarter, so one a day, and

that is usually considered

sufficient since they don't expect

a type 2 to test every day if in

good control. You must have a good

insurance? My wife tests about 5

times in 2 days as she has

gastroparesis and I give her some

of my strips.

> Sorry about not making my original

> post clearer.

Oh, no, it was a very good post and

I thank you for it. I learnt some

new things from it.

> The main point was that people

> are individuals, and we should

> not assume that what will work for

> us will work for them - and vice

> versa.

If you are referring to treatment,

then I agree. But the principles

of nutrition are not tailored to

individuals, not over here at any

rate, but quantities are determined

according to age groups, sex,

whether pregnant or lactating, body

weight and things like that, but

apart from special cases of

intolerance or allergies, the

official nutritional recommendations

are applied to everybody alike.

> Test yourself to make sure that

> your body is dealing with the

> food you eat, ...

OK, so that is where we differ. I

don't do that. I run on autopilot

and trust that the system and my

medication are taking care of it.

If something was radically wrong

then I reckon that it would show

up at my next HbA1c and I cannot

see me hand-operating my metabolism

with only a BG meter to go on.

It would be different if I was

using insulin but I am not. My

500mg Glucophage each day gives me

HbA1c of around 5.4% every quarter

and that is what matters to me.

The individual BG readings in

between do not bother me too much.

As you said: Different strokes for

different folks!

If you are taking so many readings

every day, how do you get away

from the atmosphere of being " sick "

all the time? Doesn't that detract

from your " quality of life " somewhat?

> ... rather than restricting your

> diet according to what someone

> else tells you is 'bad for

> diabetics'...

There I agree with you.

> Melisma (slinking shamefaced back

> under her Rock)

I am intrigued by the " slinking " ,

Melisma, and have been meaning to ask

you about it. What is behind that?

Regards

[Guest guest]

that's interesting. where i go, while regimens are being worked out,

one tests 7 times a day minimum. more when exercising or driving at

an usual time. i'm type 1, but that seems to go for both types. when

things are worked out, then it goes to 4 a day min.

'course i go to a research hospital. they did some studies, though,

that showed intensive management made a huge difference in

complication rates, and also in reducing existing problems. however,

i know it's definitely not the standard program. my insurance

definitely had to be persuaded to pay for so many test strips.

rach

OK, I don't know what your circum-

stances are but if you were a usual

NIDD type 2 isn't that a lot of tests,

4 a day? In Germany, the health

insurance normally pays for 100

strips a quarter, so one a day, and

that is usually considered

sufficient since they don't expect

a type 2 to test every day if in

good control. You must have a good

insurance? My wife tests about 5

times in 2 days as she has

gastroparesis and I give her some

of my strips.

[Guest guest]

Hm... addresses several different things in his post. I think

I'll snip his quotes of my message and just quote him. (Does that

make sense? LOL)

> What do you mean by " a new food " ,

> Melisma, and how do you " work it

> into the diet " ?

By 'a new food' I mean a food that you haven't had yet, or at least

haven't had since you were diagnosed (esp if you are newly

diagnosed) - or even if you've had medication adjusted recently, as

I've found that on different doses of my meds, various foods might

react differently. Or exercise changes - as mine has recently - and

you find that you tolerate a food better than you had before.

To work it into the diet... Well, my dietician and I have worked out

a meal plan for me - she's fixed a certain number of calories that I

should get every day. I don't count calories or carb grams per se,

but I do know how many carb grams are supposed to be in a starch

choice, a milk choice, a fruit/veggie choice, etc. And we've decided

on approximately how many of each choice I should have each day, at

each meal or snack. That's my diet. Now, at times I can't get, say, a

milk choice in at a particular meal. (Might be because I've run out

of milk, and don't have the money to get any more until next week,

for eg.) But because I know how many carbs are in a milk choice, I

could substitute an equivalent number of carbs from a high-calcium

veggie choice for it.

Or, perhaps I really would like a small serving of peach cobbler for

my dessert when I'm being treated to a birthday lunch (as I was last

week) - it's got sugar in it, and crust, so I counted that as at

least one carb choice, perhaps two, depending on how large the

serving was. And there was some fruit in it. Well, it was a buffet,

so I ran all around the serving area to see what I might like to

have, and I saw the cobbler. So I made sure that I didn't eat all my

carbs and fruits during the meal, but made room for some at the end.

And because I wasn't too sure of the exact carb content of the

cobbler crust, I made sure that I got a little extra exercise in

after lunch to burn off any extra sugar that might have resulted.

Or sometimes I really do want to have two fruits at a meal, when my

meal plan calls for only one. So I need to subtract one fruit from

another meal or snack so that I don't get too many carbs net in one

day.

So I guess what I mean by 'working a food into the diet' is just

figuring out what food group it belongs to, and then how much carb,

protein, and/or fat, it contains, so I know what else I can have at

that meal, or during the day, so that I can stick to my limits. It

adds a flexibility to my diet that helps me not get bored with what I

eat, and get a variety of foods and nutrients that I might not

otherwise.

> The idea of " working a new food

> into the diet " is a new one on me.

> I cannot even remember seeing a

> new food in years, everything is

> pretty much the same as it has

> always been around here!

I don't know what kinds of produce, or food products you may have

where you live. But I've personally discovered that I love trying new

things. For example, I spent a year in Korea last year, and was

always trying new stuff - daikon radish, fresh or pickled, has become

a favourite of mine, as have kimchi and doenjang paste, to name a few

things. If you can't find new stuff in your regular grocery shops,

try going to foreign food shops, restaurants that specialize in a

cuisine you've never tried before, or making friends with people from

cultures you've never rubbed shoulders with - once I had a student

who was Greek (this was before I'd discovered the joys of Greek

restaurants), who brought me several genuine Greek recipes to try.

Look online for new recipes. Be adventuresome. Just 'cause we are

diabetic doesn't mean we have to have a boring gastronomic life!

> OK, I don't know what your circum-

> stances are but if you were a usual

> NIDD type 2 isn't that a lot of tests,

> 4 a day? In Germany, the health

> insurance normally pays for 100

> strips a quarter, so one a day, and

> that is usually considered

> sufficient since they don't expect

> a type 2 to test every day if in

> good control. You must have a good

> insurance? My wife tests about 5

> times in 2 days as she has

> gastroparesis and I give her some

> of my strips.

Well, I speculate that my provincial medical coverage is pretty good.

Here in Canada everyone must have government health insurance, which

varies from province to province in terms of premiums and coverage.

I'm in British Columbia, on the West Coast. There are a few things it

doesn't cover, or covers only limited amounts of. Like chiropractors

and podiatrists, I know of for sure. Once you are covered by BC

Medical, then you get your meds and strips via Pharmacare. Pharmacare

has a graduated system based on your income that determines how much

of your meds and strips are covered by you, and how much by them. My

income last year was such that I pay 30% of those costs, up to $200

for a year - they pay the rest. If I'd have had more income, I'd have

to kick in more. But what that means is, within reason, I can get all

the strips I need - because I've reached the $200 mark long ago. I

was taught that the more I can test, the more I can keep my sugars in

line. And the more that I can avoid complications due to sugar

fluctuations, the better off I'll be in the long run. (I've also been

told that I personally don't *need* to test more than once a day if

I'm in good control, but I feel like I need to test more, especially

when adjusting meds, experiencing lots of stress, exercising more,

or, as I've said, eating new foods. And testing more even when I'm

not in those situations, just makes me feel better about myself and

how I'm caring for myself.)

> If you are referring to treatment,

> then I agree. But the principles

> of nutrition are not tailored to

> individuals, not over here at any

> rate, but quantities are determined

> according to age groups, sex,

> whether pregnant or lactating, body

> weight and things like that, but

> apart from special cases of

> intolerance or allergies, the

> official nutritional recommendations

> are applied to everybody alike.

Oh no, I agree that principles of nutrition are the same for

everyone, tailored to their general circumstances. What I'm concerned

with is that if we are told we must not eat such and such a food

because it is 'bad for diabetics', that is being too broad. Certain

diabetics may well be able to deal with that food, whereas others may

not. And to deny the person who *can* deal with it, the nutritional

value that it offers, just because another person can't, is just...

well, I don't feel comfortable with the idea.

> > Test yourself to make sure that

> > your body is dealing with the

> > food you eat, ...

>

> OK, so that is where we differ. I

> don't do that. I run on autopilot

> and trust that the system and my

> medication are taking care of it.

>

> If something was radically wrong

> then I reckon that it would show

> up at my next HbA1c and I cannot

> see me hand-operating my metabolism

> with only a BG meter to go on.

As you probably know, an HBA1C reading measures your mean blood sugar

levels for a three month period. So my endocrinologist orders one

every three months. In my view, that's just too long a time to go by

without knowing what's happening in my body. I'd rather micro-manage

it than to realize after three months that I'm doing something wrong

and maybe by that time there's been some damage to my eyes or my feet

or worse. Indeed, I've had many lows where I didn't feel any

symptoms, but when I tested before my meal, there it was. For a

period of a week, several times, I had excessive highs or lows that I

couldn't detect without a meter test - and when I called my doctor

about them, he immediately adjusted my meds to correct them. And now

that I'm exercising daily at Curves, I'm having to adjust meds almost

daily to avoid lows. Actually, it's rather exciting, because I'm able

to see results of my exercise almost immediately, instead of waiting

a month until measuring day, or three months for the next AIC.

But of course, that's me. I understand that others take a different

view, for whatever reason, and that's okay, too...

> If you are taking so many readings

> every day, how do you get away

> from the atmosphere of being " sick "

> all the time? Doesn't that detract

> from your " quality of life " somewhat?

Not really. I've just adopted it as one of the rituals of preparing

for a meal, the same as washing hands or setting the table. The only

thing is, some people around me might object to the sight of the

blood on my finger, so I've learnt to take my reading unobtrusively

if I'll be eating with people.

I don't take the attitude that it's an atmosphere of being 'sick' -

rather, that I'm keeping myself from *getting* sick. I've had some

terrible results of letting my sugars go - in Korea for eg, during

the time when I was adjusting to the new foods and hadn't figured out

the best way of incorporating them into my diet, I was bit by a

mosquito on my back one night. It was really itchy, of course, so I

scratched at it. I opened up a large sore in my back that took

several months to heal. Believe me, that was incentive enough to keep

testing, and planning my meals better!

> > Melisma (slinking shamefaced back

> > under her Rock)

>

> I am intrigued by the " slinking " ,

> Melisma, and have been meaning to ask

> you about it. What is behind that?

Ah 'To slink' can mean to go quietly, without much commotion. When

I wrote that last post, I was a little embarrassed (shamefaced)

because I had not made something clear in my previous post. So I was

signing off quietly in my embarassment. The Rock is sort of an online

trademark of mine - in my signatures I always mention it, and what

I'm doing under, on, in front of, etc, it. On some lists, I'm known

as The Girl With The Rock, and sometimes when other listmates make a

mistake and are embarrassed they will ask if they can come hide under

Melisma's Rock. It's just an ongoing online gag

Best,

Melisma (under her Rock, wondering what she should have for a bedtime

snack, so she won't have a midnight low...)

[Guest guest]

> that's interesting. where i go,

> while regimens are being worked out,

> one tests 7 times a day minimum.

> more when exercising or driving at

> an usual time. i'm type 1, ...

Hi, , thank you for the reply.

I can imagine testing frequently

when using insulin because of the

hypo risk ....

> ... but that seems to go for both

> types.

.... but I still cannot see the need

for type 2s taking oral medication

(for which there is no real hypo

risk) to measure so frequently.

> ... when things are worked out,

> then it goes to 4 a day min.

That still seems to me to be

excessive for type 2s on oral med-

ication. If I measured so often

that would mean I would be col-

lecting measurements at the rate

of 28 a week. What am I going to

do with all that information?

It just seems like overkill to

me!

A blood glucose measurement is

always invasive and I thought

that good medical practice was

to reduce invasive treatments

to a minimum. So I guess my

question really is, what is the

*minimum* number of measurements

for a type 2 on oral medication

and what tangible advantage is

obtained by making more than

that? At the moment, I am making

on average 3 a week, mostly

fasting BG, and my physician is

satisfied with that.

> they did some studies, though,

> that showed intensive management

> made a huge difference in

> complication rates, and also in

> reducing existing problems.

As I understand it, intensive

management refers to close control

with insulin to enable a lower

HbA1c to be obtained without

increased hypo risk. I don't see

how type 2s on oral medication

can be intensively managed,

though.

> ... however, i know it's

> definitely not the standard

> program. my insurance definitely

> had to be persuaded to pay for

> so many test strips.

Ah! OK, so that would be an

explanation: it could have been a

special program to collect

information for a study.

I have heard that physicians in

North America habitually prescribe

significantly higher doses of oral

blood glucose-reducing medication

than do physicians in Europe and I

was wondering if the same generosity

applies to their recommendations

for BG testing frequency.

Regards

[Guest guest]

> By 'a new food' I mean a food

> that you haven't had yet, or at

> least haven't had since you were

> diagnosed ...

Hi, Melisma! What a terrific posting!

You sure have packed a lot of

information in there, thanks a lot!

> ... if you've had medication

> adjusted recently, as I've found

> that on different doses of my

> meds, ...

OK, but how often does oral medi-

cation get adjusted? Once every 2

to 3 years? That would be a special

case and I would probably make some

extra measurements then, too.

> ... various foods might react

> differently. Or exercise changes -

> as mine has recently - and you

> find that you tolerate a food

> better than you had before.

I long ago found that the blood

glucose change made by exercise is

of short duration (15 minutes or

so) and never sent me anywhere

near a hypo so in my case at least,

exercise does not justify a test

strip. The long-term improvement

from regular exercise takes place

over months and shows up better

on the HbA1c than on individual

BG readings, I found.

As for " tolerating food " , I don't

have any food intolerances that I

ever noticed and if I did then I

guess they would show up in other

ways than as elevated blood glucose!

> To work it into the diet...

> Well, my dietician and I have

> worked out a meal plan for me -

> she's fixed a certain number of

> calories that I should get every

> day. I don't count calories or

> carb grams per se, but I do know

> how many carb grams are supposed

> to be in a starch choice, a milk

> choice, a fruit/veggie choice, etc.

> And we've decided on approximately

> how many of each choice I should

> have each day, at each meal or

> snack. That's my diet. Now, at

> times I can't get, say, a milk

> choice in at a particular meal.

OK, now I am beginning to understand!

For me, you are describing life on

a different planet! I do monitor my

food closely and calculate what it

was I ate in terms of calories and

macronutrients, fiber and water as

an average for the week or so as a

part of my weight-reduction program.

But I don't plan anything in advance,

apart from buying only " healthy "

(i.e. fresh) food so what we eat is

limited to what we have bought. I

am convinced that the whole deal is

decided in the supermarket - whatever

we buy gets eaten sooner or later,

what we leave behind in the super-

market we can't eat anyway!

It is a quite different nutritional

philosophy, isn't it? You plan meal-

by-meal and we plan week-by-week!

Since the effects of nutrition are

very, very, slow, I reckon that a

weekly average is all I need to know.

You seem to me to be out to hand-steer

your complete metabolism! I trust

in millions of years of evolution

to do the job!

> Or, perhaps I really would like

> a small serving of peach cobbler

> for my dessert when I'm being

> treated to a birthday lunch (as

> I was last week) - it's got sugar

> in it, and crust, so I counted

> that as at least one carb choice,

> perhaps two, depending on how large

> the serving was. And there was

> some fruit in it.

Oh, man! You must have been the life

and soul of that party! One small

serving of anything at all for a

birthday party is not going to

upset anything, especially since you

are otherwise so strict. That is what

I meant by " quality of life " !

> So I made sure that I didn't eat

> all my carbs and fruits during the

> meal, but made room for some at

> the end. And because I wasn't too

> sure of the exact carb content of

> the cobbler crust, I made sure that

> I got a little extra exercise in

> after lunch to burn off any extra

> sugar that might have resulted.

But you weren't taking BG readings

before and after everything, were

you, Melisma? At your own birthday

party? Tell me you weren't, please!

> Or sometimes I really do want to

> have two fruits at a meal, when my

> meal plan calls for only one. So

> I need to subtract one fruit from

> another meal or snack so that I

> don't get too many carbs net in one

> day.

Did your dietician tell you that each

day counts for itself and that you

cannot average out over a week to

ten days or so? If so, just for me,

would you please ask her the next

time you meet what the evidence for

that is?

It goes against all the physiology

that I ever learned. Our body has

scarcely changed at all from the days

when food supply varied considerably

from one day to the next and can

store everything it needs to cover

quite long periods of short supply.

The only thing we cannot store and

average out over days and weeks is

water, but eating 2000 kcals one day

and eating 1000 kcals the next is

not practically any different from

eating 1500 kcals on each day and

is certainly about as natural as you

can get. If your dietician has a

good explanation to the contrary,

I am just burning up to read it!

> So I guess what I mean by 'working

> a food into the diet' is just

> figuring out what food group it

> belongs to, and then how much carb,

> protein, and/or fat, it contains,

> so I know what else I can have at

> that meal, or during the day, so

> that I can stick to my limits.

Yes, I now understand what it means

but I don't see any nutritional

reason for doing that. Now you say

that you are not only trying to

balance out each day but each meal

as well, do I have that right? What

is the benefit obtained from doing

that? And all the time, you are

measuring your BG before and after?

> ... adds a flexibility to my diet

> that helps me not get bored with

> what I eat, and get a variety of

> foods and nutrients that I might not

> otherwise.

OK, but it comes across to me as a

net loss of flexibility because

you can't eat what is immediately

available unless it fits into your

plan. Now I come to think about it,

that might be a good reason to do

it your way - you don't ever go

completely off the rails and just

pig out on something good but you

ARE keeping a very tight rein on

yourself that I would not be able

to put up with for long myself!

I have to admire your devotion!

> ... But I've personally discovered

> that I love trying new things. ...

> Be adventuresome. Just 'cause we are

> diabetic doesn't mean we have to have

> a boring gastronomic life!

I agree with you but in the very same

way, just because we are diabetic

does not mean that we have to punctuate

our lives with BG measurements!

> ... within reason, I can get all

> the strips I need - because I've

> reached the $200 mark long ago. I

> was taught that the more I can test,

> the more I can keep my sugars in

> line.

To me, that is just like saying that

when you have the 'flu, the more often

you measure your temperature, the more

the symptoms will subside. But it is

the medication that combats the

symptoms, not the temperature

measurement. That seems to be where

we differ most.

> And the more that I can avoid

> complications due to sugar

> fluctuations, the better off I'll

> be in the long run.

As far as I know there is no evidence

of a correlation between the number

of BG measurements per day and the

risk of any particular diabetes

complication.

Nor, as far as I know, is there any

evidence of a correlation between

blood glucose " variations " and risk

of complications.

As far as I know, the only strong

correlation is between glycosylation

and the risk of certain complications

but we do not have a glycosylation

meter.

There is experimental evidence of a

correlation between the area under

the elevated-BG-against-time curve

and glycosylation but that requires

many measurements per incident and

averaging over a large number of

incidents of elevated BG. That is

precisely what the quarterly

glycosylated HbA1c measurement

does in effect.

> I've also been told that I

> personally don't *need* to test

> more than once a day if I'm in

> good control, but I feel like I

> need to test more, .... And testing

> more even when I'm not in those

> situations, just makes me feel

> better about myself and how I'm

> caring for myself.

OK, that is an even better reason!

I can't argue with that, that is

the very same reason that my wife

gives when I nag her about using

up test strips at a great rate!

> What I'm concerned with is that

> if we are told we must not eat

> such and such a food because it

> is 'bad for diabetics', that is

> being too broad.

I agree with you there.

> As you probably know, an HBA1C

> reading measures your mean blood

> sugar levels for a three month

> period.

It measures the weighted average

glycosylated Hemoglobin A1c for

the red blood cells that you have

in your body at the time of the

measurement. Since the red blood

cells live for 90 to 120 days and

are dying by the millions every

day and being metabolised out, the

glycosylated HbA1c reading is

roughly two-thirds from the previous

30 days and one-third from the

60 days before that.

> So my endocrinologist orders one

> every three months.

The same as they do all over the

world.

> In my view, that's just too long

> a time to go by without knowing

> what's happening in my body.

> I'd rather micro-manage it than to

> realize after three months that

> I'm doing something wrong ...

I believe that fear is ungrounded.

Things don't move that quickly

without you finding out about it

in other ways (fever and other

symptoms).

> ... and maybe by that time there's

> been some damage to my eyes or my

> feet or worse.

I don't believe that it can change

that quickly. When I was diagnosed

with Type 2, I had HbA1c of over 13%.

When the eye doctor examined me he

said that he could see no damage

to my retina. When I asked him if

that meant I wasn't going to get any,

he replied: " How should I know? Come

back in 5 years time and I will tell

you then. " The condition of your

retina has a function similar to the

glycosylated HbA1c measurement but

is related to your average elevated

BG over the previous 5 years.

Things don't change very rapidly in

that respect.

> Indeed, I've had many lows where

> I didn't feel any symptoms, but

> when I tested before my meal,

> there it was. For a period of a

> week, several times, I had

> excessive highs or lows that I

> couldn't detect without a meter

> test - and when I called my doctor

> about them, he immediately

> adjusted my meds to correct them.

OK, now I see better. Those are all

signs that you do not yet have good

control. When you do, those things

won't happen to you (so often). You

have something to look forward to!

> ... I'm having to adjust meds

> almost daily to avoid lows. Actually,

> it's rather exciting, because I'm

> able to see results of my exercise

> almost immediately, instead of

> waiting a month until measuring day,

> or three months for the next AIC.

I know the feeling!

> The only thing is, some people

> around me might object to the sight

> of the blood on my finger, so I've

> learnt to take my reading

> unobtrusively if I'll be eating with

> people.

Another good reason to give it a miss

when eating out! My blood spattered on

the white table cloth spoilt many a

dinner out when I first started! It

is not nice to be left sitting there

while everybody else moves to a

different table.

> I was a little embarrassed (shamefaced)

> because I had not made something clear

> in my previous post.

Oh, man! I would need to have a cave to

hide in if I think of all the times I

have not made something clear!

Melisma, this is the fundamental point

about e-mail self-help groups. People

might be able to get something useful

out of reading other people's posts but

they get a hundred times more out of

writing something themselves. It doesn't

matter a cent if it is incoherent and

unclear! What brings the benefit is in

getting your thoughts clear in your own

head and putting them down in words for

the whole world to read if they want to!

I am writing all this mainly for my own

benefit and I thank you for giving me the

opportunity. I hope you got something

out of it in return. Don't worry about

being unclear - I wish I could be as

clear!

> On some lists, I'm known as The Girl

> With The Rock, and sometimes when

> other listmates make a mistake and

> are embarrassed they will ask if

> they can come hide under Melisma's Rock.

That is very nice! I like it! I

would ask you to save a place for me

but I don't feel embarrassed very

often these days and I probably would

not fit in!

Regards

[Guest guest]

> > ... but that seems to go for both

> > types.

>

> ... but I still cannot see the need

> for type 2s taking oral medication

> (for which there is no real hypo

> risk) to measure so frequently.

I'm only going to comment on this statement, . As a matter of

fact, there *are* oral medications that type 2s take which mimic

insulin, and which can cause lows - I'm on one, glyburide. At times I

have a terrible problem with lows, and my frequent testing has

prevented some nasty results. However, I know from my time in Korea

that treatments vary from place to place - I couldn't refill my

glyburide prescriptions in a Korean pharmacy, and had to have my

mother send it to me from Canada.

Melisma (shutting up for a while - she hopes! - here under her Rock)

[Guest guest]

hi derek!

yes, i definitely go to a research hospital (they just did some

islet cell transplants as a matter of fact). but in a way, here in

the U.S., it's all a muddle as to what is and isn't experimental,

what is and isn't *good standard care.* the studies they did were so

conclusive, my hospital considers the experimental standard and

everything else substandard or just bad.

healthcare is incredibly variable over here. i'd say it's a fact

that there are many doctors out there prescribing overdoses / wrong

doses / wrong meds all together.

in my week long education class (which was only the first part and

also unusual), i met a man who had been prescribed *seizure doses*

of insulin. he'd been blacking out and waking up with blood

streaming out of his nose. i've known folks to be prescribed insulin

and sent home without any dosing guidelines. people came from very

far because of such *standard care.*

anyways, where i go, they define intensive management as frequent

testing and having a diabetic care team, among other things. which

is another thing, a lot of people only see a single general

practitioner and zero specialists. not even a dietician.

there are oral meds that can make one go low, i think melissa

mentioned them. there is the acute danger of acute lows - but i

think the other reason my med facility wants frequent testing is

because the HbA1c is an average. so, for instance, one could have a

lot of liveable highs and lows and the test would look just fine,

but the reality is a different picture. they are looking to catch

anything as soon as possible, see if the medication is really right,

and i'd say enabling patients to do it themselves.

and that's yet another thing, also learned a lot of doctors will

settle for HbA1c's of 9+ and so forth. there is / has been an

expectation that diabetes will *progress,* that the complications

are diabetes itself. so people are set up for them, not realizing

how directly correlated the complications are with management.

suppose i could go on. have heard a lot of horror stories and

experienced some. i personally would not leave anything up to our

medical system if it can be avoided. and actually, you know, my

quality of life hasn't changed at all. it's quite surprising. i

flash the gear, it's all over in a few seconds, and it's like

nothing happened. really, i'd like an *ooh and ahh* for my cool

meter. lol!

ok. better stop, before i right a book!

rach

> As I understand it, intensive

> management refers to close control

> with insulin to enable a lower

> HbA1c to be obtained without

> increased hypo risk. I don't see

> how type 2s on oral medication

> can be intensively managed,

> though.

>

> > ... however, i know it's

> > definitely not the standard

> > program. my insurance definitely

> > had to be persuaded to pay for

> > so many test strips.

>

> Ah! OK, so that would be an

> explanation: it could have been a

> special program to collect

> information for a study.

>

> I have heard that physicians in

> North America habitually prescribe

> significantly higher doses of oral

> blood glucose-reducing medication

> than do physicians in Europe and I

> was wondering if the same generosity

> applies to their recommendations

> for BG testing frequency.

>

> Regards

>

>