Wednesday, 7 October 2009

We know best – no need to test!


Internet diabetes forums frequently raise the issue of blood glucose testing for people with Type 2 diabetes, especially those not on medication but following a diet and exercise regime to keep their levels under control. The issue, more often than not, boils down to one thing – money. Test strips cost the NHS around £13 for 50 strips. Multiply that by the millions of people with diabetes and it amounts to a not inconsiderable sum. If you are on an insulin regime, particularly multiple daily injections (MDI) or insulin pump delivery, then there is normally no question – you must test your levels before decding how much insulin to inject. However, for those not on insulin, and maybe not on any form of medication for their diabetes (i.e. diet and exercise), the issue is not as clear cut.

Many doctors do not support regular blood testing for such people, arguing that it will not improve control and is therefore an unnecessary expense. Accordingly, they will not prescribe strips, often as a general policy which excludes all Type 2 diabetics, regardless of circumstances. In many cases, this may be true. If a person is allowed to test but then makes no adjustments to diet and activity levels in response to the readings then the test was virtually worthless, possibly even causing increased stress and anxiety if the result was high. On the other hand, however, if a person tests in order to discover how certain foods or food combinations affect their levels and then acts on this to make dietary adjustments, then the test is extremely valuable!

The alternative often provided to testing is a three or six monthly HbA1c blood test, but this cannot show how a particular meal proved particularly good or bad to the person – that information is impossible to determine. So the person is left knowing something has gone wrong but never knowing what. Improved control will not be achieved in this way, and the person may eventually be placed on increasing amounts of medication to control their levels, finally progressing to diabetic complications costing the health service thousands of pounds to treat.

It is arrogant and insulting for a doctor or nurse to deny a person the means to improve their health by suggesting that their treatment is a financial burden where corners can be cut, when that person is willing and capable of working hard to maintain a full and healthy life.

You what, my dear? You test yourself four times every day?!!!
We’ll put a stop to that right now, that’s really not our way!
I think you’ll find those strips you use cost us too much money –
The doctor saw the price one day and came over all funny!

You must agree with me my dear, it’s really common sense,
You’re not on drugs, so it is an unnecessary expense!
What is the point of testing? Perhaps you like the pain?
I tried it once, believe you me, I won’t try that again!

You’re not a health professional dear, so take a tip from me,
Let us decide what’s best for you, I’m sure one day you’ll see,
Although you may succumb one day to losing sight or limb,
We’ll save the NHS some cash – our budget will be trim!

Before you go, please don’t forget to eat with every meal
A lot of rice, or spuds, or bread – don’t worry how you feel!
We’ll test your blood two times a year, so there’s no need to fuss,
Where would you diabetics be if it wasn’t for people like us?!!!

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