The majority of people with poorly controlled diabetes, feel well in themselves and have no symptoms for a long time until complications occur
Choose to test regularly and choose your test wisely. Ditch the ostrich attitude and take the first step to diagnose the problem to find ways to solve it.
Diabetes is unfortunately a symptomless condition unless your blood sugars are extremely high or low. Therefore, the majority of people with poorly controlled diabetes, feel well in themselves and have no symptoms for a long time until complications occur. This also explains why nearly 50% of diabetes is undiagnosed in India. Therefore, we are heavily reliant on tests to monitor diabetes control, to guide treatment change and advice.
“People who test their blood sugars more often, are more health aware, more willing to make lifestyle changes to address any problems and are likely to have overall better diabetes control than those who don’t. People who don’t test, have the “ostrich problem”. They worry about facing the truth and how the truth will restrict their lifestyle and therefore prefer to go about life in oblivion, believing that all is good,” says Dr Hema Venkataraman, Medical advisor, New Initiatives, Practo, Consultant Endocrinologist and Senior Lecturer, University Hospitals Birmingham, NHS, UK. This is of course a coping mechanism to avoid facing the negativity of a diagnosis of poor diabetes control.
Dr Venkataraman shares the various tests you can use to check your progress and control.
The urine test for glucose was historically used as a means to diagnose and monitor diabetes control. It is inaccurate, unquantifiable and has given way to more reliable tests.
Fasting and Postprandial Blood sugars: (FBS / PPBS)
It is a commonly used blood test done in the lab, measuring your fasting and post meal blood sugar. It is a point in time test and is slowly paving the way to HbA1c.
- Pros: Quick test, fasting blood sugar tests are fairly accurate, affordable, available even at small labs in rural and remote areas
- Cons: PPBS is very variable based on the size of meal, only a point in time test not a measure of long term control or trends
Hba1c is a measure of your diabetes control over the last 8-12 weeks. It measures the amount of sugar bound to the red blood cells (which have a life of 2-3 months). ADA recommends HbA1c every 3-6 months: 3 months if your control is not optimal or 6 months if it is. Unfortunately, only 13 % of our diabetes population even gets the yearly check.
- Pros: Indicates long term control – so you cannot cheat the system, reliable and accurate.
- Cons: Reliant on lab, takes 3 months to change, so doesn’t help you to make short term changes in day to day life.
Frequent Home Self monitoring of BG (SMBG) using a glucometer has been shown to improve overall glucose control.
- Pros: do it at home yourself, affordable, can give you information on your control at any point in time
- Cons: Not as reliable as hba1c, meters have different margins of error, painful test, needs effort and volition. It is only a “point in time” test – does not give you trends. A lot of regular readings are needed before the doctor can make meaningful changes to treatment.
“Flash glucose monitoring / continuous glucose monitoring is a huge leap in technology from the finger prick test. A small patch (10 rupee coin size) is stuck on your arm and measures your sugar levels every minute. All you have to do is to scan this patch with your phone or a reader and it sends you reading at that time and your sugar trends and graphs for up to 14 days,” adds Dr Venkataraman. You can use this in real time to experiment and learn the effects of various foods, (many of which you previously thought were healthy), exercise, medications, alcohol and much more. Total time spent in range (70-180mg/dl) is a good marker of your control and correlates with your Hba1c. The time in range will slowly replace the Hba1c, as an emerging marker of overall control. Through the cloud, you can transmit your blood sugars in real time to another family member or even to your doctor. From high performance athletes to children and elderly with poor vision, this device has changed the scene of diabetes monitoring.
Its regular use has been shown to improve Hba1c, weight, reduce glucose fluctuations, reduce glucose medications, less hypoglycaemia, and improve quality of life significantly. There is also evidence now the CGM use will change behaviors and can be used as an educational tool to modify lifestyle and health habits.
- Pros: painless and instant blood sugar results, gives trends and patterns with > 1400 readings /day.
- Cons: Cost – ranging from nearly 8-10k/month. Also the psychological burden of knowing too much, can cause anxiety. Margin of error of up to 10%.
Choose to test regularly and choose your test wisely. Ditch the ostrich attitude and take the first step to diagnose the problem to find ways to solve it.
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