This article was first published in The Montreal Gazette.
Many diabetics check their blood sugar regularly at home. On the surface, this seems like a good idea since controlling your diabetes can prevent some of the worst complications of the disease — namely kidney failure, vision loss and even foot infections leading to amputations. But many diabetics may be checking their blood sugar unnecessarily and wasting a fair amount of money in the process.
Type 1 diabetics do need to check their blood sugar in order to adjust their insulin doses. In Type 1 diabetes the pancreas does not produce enough insulin to meet the body’s needs and this leads to a rise in blood sugar. For now, there is no real alternative to insulin treatment short of a pancreas transplant, which for obvious reasons is reserved only for very severe cases.
Type 2 diabetes is another matter altogether. In Type 2 diabetes, the problem is not insufficient insulin but rather insulin resistance. Giving patients more insulin to drive down blood sugar levels does work, but it does not address the underlying problem. Notwithstanding the inconvenience of having to inject yourself with insulin multiple times a day, and the unfortunate weight gain that tends to accompany its use, the main drawback of insulin therapy is the risk of hypoglycemia.
While most people worry about the consequences of hyperglycemia (high blood sugar), hypoglycemia (low blood sugar) can be just as dangerous. Taking too high a dose of insulin can drive your blood sugar into dangerous low levels, cause you to slip into a coma and ultimately die. But even non-fatal hypoglycemic episodes seem to portend a worse prognosis. Studies have shown that patients with frequent hypoglycemic episodes have worse outcomes than those who do not. The American Diabetes Associations puts the cutoff for hypoglycemia at a blood sugar under 4 mmol/L, although some have suggested that under 3.5 mmol/L is more appropriate.
Regardless, the risk of hypoglycemia with insulin therapy has been largely responsible for the push to rely more on medications rather than insulin to treat Type 2 diabetes. Metformin is generally seen as the first line medication given its long track record, good effectiveness and low cost. More important, it does not cause hypoglycemia.
Sulfonylureas were another class of medication that were commonly used before but have gradually fallen out of favour because of the hypoglycemia risk.
In the days when insulin and sulfonylureas were commonly prescribed, there was a good argument to be made for keeping tabs on your blood sugar at home since a quick glass of juice could avoid a hypoglycemic episode. But as medical therapy has gradually moved away from these therapies, the value of home glucose testing has also diminished. In fact, most physicians now rely mostly on a blood test called Hemoglobin A1C, which gives a more reliable three-month average of your blood sugar control.
The problem with home glucose monitoring is that the information is not necessarily useful for gauging the effectiveness of diabetes control. It is also costly because while the machines themselves are cheap and often given away for free, the single-use strips are not. At about a dollar per strip, the economic impact adds up over time. Also, in patients not taking insulin it is unclear if home monitoring has any benefit. Recently Choosing Wisely recommended against home glucose testing in Type 2 diabetics unless they are taking insulin or medications that cause hypoglycemia.
While checking blood sugar at home could give people a sense of control over their disease, changes in how we treat and monitor diabetes may have made these devices unnecessary for many. And at a time when everything is becoming more expensive this may be one way to save your money.
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