• Control through testing
  • Who needs to test and when?
  • Why do a test?
  • Can I get real control?
  • Control through testing

    Pricking a finger to take a blood-sugar reading is one of the basic chores of living with diabetes, both for type 1 and type 2. Glucose meters have been changing gradually over the years, and the glucose sensor strip is the norm now for all new meters. These are more accurate and reliable than in the past, and there is less messing around wiping blood off the strip, or waiting for a beep. If you still have an older meter, it's time to change it.

    It isn't just the meters that have changed. I had the original finger-pricking device in the late 1970s, it had the kind of spring that could launch a clay pigeon. Now we have super fine lancets, and devices with adjustable depth. We should all use these, so we get pricked just deep enough to produce the tiny drop of blood we need. Some meter companies offer alternate site testing, and this can be useful for musicians for example.

    Who needs to test and when?
    First, everyone with type 1 diabetes should test themselves regularly. Blood glucose can rise and fall very unpredictably in type 1, so we need to test around four times a day. Type 2 is not so clear-cut. If we look for scientific proof that testing improves control in type 2, we won't find it. Some people don't wish to test at all, or rely on urine testing for glucose.

    These might be acceptable for someone who is diet-controlled, or whose A1c is just right. It is also reasonable for elderly people who are frail or have poor eyesight. However, urine testing alone is only a vague guide to blood glucose.

    Since many people with type 2 progress over time to need tablets and even insulin, and as these usually bring a risk of hypoglycaemia (low blood sugar), it becomes useful to have some way to check that your blood sugar is alright.

    Even in type 2, tighter control helps prevent complications, and occasional blood tests in the clinic won't always be enough to achieve this. Hence, we test at home as well. In my own practice, I encourage people with type 2 to start testing when they start tablets.

    This might be once a day or even twice a week initially, but once a person needs insulin, they will need to test two to four times a day.

    Diabetes during pregnancy needs close monitoring and control, so women are asked to test at least four times a day. In general terms, the tighter the control you need, the more often you need to test.

    Why do a test?
    Most people start testing because their doctor asks them to. I suggest that once we know why we are testing, we have more reasons to test than our team can think of!

    Remember blood glucose testing is not testing you, it's testing the balance between your treatment on the one hand, and your meals, activity and metabolism on the other. Most tests before a meal are testing the treatment before that meal. So, for a type 1, your lunchtime reading tells you if your fast-acting morning insulin is working and so on.

    This guy is just a goody goody, right? ‘fraid not. The ‘guillotine' I previously used, put me off testing so much that I went several years at one point without testing at all!

    I'd like to reach out to people reading this who don't test much, if at all. Think about this: in 5-10 years' time, when type 1 can be controlled with even less effort than now, don't you want to be free from complications? If so, with a little effort, perhaps as little as four tests a week, the risks can be cut by 60%, 70% or even 80%.

    Can I get real control?
    Testing really can give you real control, help you prevent embarrassing hypos and long-term consequences. And when we test, we should be able to do something about an unexpected result. Let's take a few examples:

    Jack has type 1, and is a student. He usually takes Humalog 8 units with his breakfast and 10 with his lunch. His morning blood sugar is high at 12mmol/l, so he adjusts his own insulin to allow for that by taking an extra unit, 9 instead of 8. At lunchtime, his glucose is 6.4, not bad. He's playing sports in the afternoon, so he takes his usual insulin, but he tests again and drinks and eats carbohydrates before playing.

    Sam is a 63-year-old retired Garda and amateur hill-walker. He takes Glucophage and Diamicron tablets twice a day. He usually tests once a day, but he has the flu so he's testing three-four times a day to check for high sugars. His morning sugar is 10.2, but by lunchtime it's 15, so he checks his urine for ketones. They are clear, but he phones his GP and arranges to see her in the morning.

    Testing is a lifelong chore, but we have come a long way. The next steps include bloodless testing, and implantable, continuous sensors.

    Tony O'Sullivan is policy committee chairman of the Diabetes Federation of Ireland and is a GP with diabetes

    Issue December 03