Friday, November 16, 2007

When to Test Blood Sugar in Type 2

One of the topics that comes up a lot in the email I get from visitors to my What They Don't Tell You About Diabetes web site is the question of when is the best time to test your blood sugar.

A lot of doctors still tell people with Type 2 to test first thing in the morning and before meals. That was what I was told at diagnosis in 1998. People who test using this schedule may tell you their blood sugar is usually 120 mg/dl, which sounds pretty good, except that since this is a fasting number it usually hides the information that the person's blood sugar maybe going to 250 mg/dl or higher after every meal.

Research has shown that for people with Type 2 diabetes--especially those who have been diagnosed recently and still retain some beta cell function--it is the high spikes after meals that contribute most heavily to raising the A1c and causing complications. If you only test your fasting blood sugar, you will not know anything about how high your blood sugar is spiking after meals, so you won't know which foods are toxic to you because they cause dangerous spikes.

If you are like most people with Type 2 your access to the very expensive blood sugar testing strips is limited. You may have to pay for strips yourself or your insurance may pay for a single box each month. That means that you need to use each strip as efficiently as possible. Here are some strategies that you can use to get the information out of your blood tests that will let you drop your A1c back into the healthy zone.

  1. Keep a written log that matches what you eat with the test result you get.
    Even though your meter may keep a list of your readings, these readings are meaningless unless you know what food you ate that resulted in each particular reading. If you write down what portion size of which food you ate and match it to the blood sugar you saw after eating it, you will accumulate the information you need to eliminate toxic foods and replace them with those that do not raise your blood sugars.


  2. Determine when your blood sugar reaches its highest point after eating.
    Your goal is to bring your blood sugar peaks below the level that we know cause complications. To do this, you need to learn when your blood sugar hits its highest level. Research studies show that the average person sees a blood sugar peak 75 minutes after eating carbohydrate.

    But you're not average, you're you. So the first thing you need to do is determine when your own blood sugar peak occurs. Start out by testing at 1 hour, 1.5 hours, 2 hours, and 3 hours. Do this for three meals. You should start seeing at which time the highest reading occurs. That's the time you should plan to test in the future.

    Don't test at 30 minutes after eating. Though many people see a high at this point, research has shown that brief peaks at 30 minutes after eating do not correlate with an increased incidence of complications. The one hour reading is the earliest that you should concern yourself about.

    If you eat pasta which digests very slowly you may see a peak much later than usual. You should test for peaks from pasta 4 or 5 hours after eating if you don't see them in the first 3 hours.


  3. Eliminate the Foods that Cause Unacceptable Spikes.
    You can test all you want, but if you don't use the test result to eliminate the foods that cause blood sugar spikes, you might as well not test at all. Testing is the most powerful tool you have as a person with diabetes to regain your health, but you must act on the information you get from your testing.

    If you see an unacceptable high blood sugar reading, the only way to bring it down is to cut back on the amount of carbohydrate in your meal. Carbohydrates are what raise blood sugar, and despite what you may read in books written by people who do not have diabetes, every gram of carbohydrate you eat will raise your blood sugar no matter whether it is supposedly "healthy", "low glycemic" or the label says it is magically treated to keep it from raising blood sugar.

    So if your blood sugar is too high after eating a meal, determine where the carbs came from that raised your blood sugar in that meal, and cut back on the carbohydrate food or eliminate it completely.


  4. Nutritional Software Can Help You Discover Where The Carbs Are
    I like LifeForm. Others use Fitday. Find a reliable source of nutritional information and look up the foods you eat to see where the carbs are coming from. Read the labels on the prepared foods you buy and be careful to note the portion sizes which are almost always much less than you eat. For example, have you ever gotten "2.5" servings out of a can of Campbell's soup? No. I didn't think so. But that's the portion size given on the label, so if you eat half the can, you're getting 20% more carbs than are listed on the label.


  5. Shoot for Healthy Blood Sugar Targets
    These are the targets that will give you an A1c in the 5% range no matter how high your A1c is now. If you don't believe me, check out THIS PAGE of reports from people who have used these targets to dramatically lower their A1cs.

    One hour after eating: under 140 mg/dl (7.8 mmol/l)

    Two hours after eating: under 120 mg/dl (6.7 mmol/l)

    If you can do better than this, go for it. Normal people rarely go over 120 mg/dl ever and are usually under 100 mg/dl at 2 hours after eating.


  6. Use Generic Meters and Strips if Access is Limited

  7. Wal-mart sells the Relion meter for $8.88 and the strips are less than half the price of the name brand strips. They work just as well. The drugstore brand meters made by TrueTrak are also much cheaper than the brand name strips, though the strips may lose their accuracy over time, once the vial is opened. Companies give away "free" meters only to get you using their overpriced strips. Don't pay full price for name brand strips. It isn't necessary. You can sometimes get good deals on strips on eBay but check the expiration date. Don't buy expired strips and don't buy strips by mail when it is hot as the heat can destroy them.

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