Blood sugar

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Blood sugar

Postby Dillonfamily » Thu Jan 03, 2019 9:34 pm

I recently purchased The Starch Solution because my husband is a little overweight and type 2 diabetic. I have tried implementing the recipes but it makes his blood sugar soar. How do we implement the diet and avoid the sugar spikes associated with consuming so much starch?
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Re: Blood sugar

Postby JeffN » Sat Jan 05, 2019 7:22 am

You can read how Dr McDougall treats diabetes here

https://www.drmcdougall.com/misc/2009nl ... abetes.htm

At the residential program, we only check morning blood sugar and only if the participant is checking it. Otherwise, we only check it with their initial labs and final labs.

The only exception is if Dr Lim is adjusting medications and then he may want to check it more often.

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Re: Blood sugar

Postby JeffN » Tue Apr 02, 2019 7:34 am

JeffN wrote:At the residential program, we only check morning blood sugar and only if the participant is checking it. Otherwise, we only check it with their initial labs and final labs.

The only exception is if Dr Lim is adjusting medications and then he may want to check it more often.


More on self monitoring of blood sugar

1) American Academy of Family Physicians
August 8, 2018

Don’t routinely recommend daily home glucose monitoring for patients who have Type 2 diabetes mellitus and are not using insulin.

Self-monitoring of blood glucose (SMBG) is an integral part of patient self-management in maintaining safe and target-driven glucose control in type 1 diabetes mellitus. However, daily finger glucose testing has no benefit in patients with type 2 diabetes mellitus who are not on insulin or medications associated with hypoglycemia, and small, but significant, patient harms are associated with daily glucose testing. SMBG should be reserved for patients during the titration of their medication doses or during periods of changes in patients’ diet and exercise routines.


2) Society of General Internal Medicine
Released September 12, 2013; revised February 15, 2017

Don’t recommend daily home finger glucose testing in patients with Type 2 diabetes mellitus not using insulin.

Self-monitoring of blood glucose (SMBG) is an integral part of patient self-management in maintaining safe and target-driven glucose control in type 1 diabetes mellitus. However, daily finger glucose testing has no benefit in patients with type 2 diabetes mellitus who are not on insulin or medications associated with hypoglycemia, and small, but significant, patient harms are associated with daily glucose testing. SMBG should be reserved for patients during the titration of their medication doses or during periods of changes in patients’ diet and exercise routines.


3) Glucose Self-monitoring in Non–Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings
A Randomized Trial July 2017
JAMA Intern Med. 2017;177(7):920-929. doi:10.1001/jamainternmed.2017.1233

Key Points
Question Is self-monitoring blood glucose levels effective for people with non–insulin-treated type 2 diabetes in terms of improving either hemoglobin A1c levels or health-related quality of life (HRQOL) in primary care practice?

Findings In this pragmatic randomized clinical trial that included 450 patients randomized to 1 of 3 groups: no self-monitoring of blood glucose (SMBG), once-daily SMBG, and once-daily SMBG with enhanced patient feedback. There were no significant differences in glycemic control across all groups, nor were there significant differences found in HRQOL.

Meaning Routine self-monitoring of blood glucose levels does not significantly improve hemoglobin A1c levels or HRQOL for most patients with non–insulin-treated type 2 diabetes; patients and clinicians should consider the specifics of each clinical situation as they decide whether to test or not to test.

Abstract
Importance The value of self-monitoring of blood glucose (SMBG) levels in patients with non–insulin-treated type 2 diabetes has been debated.

Objective To compare 3 approaches of SMBG for effects on hemoglobin A1c levels and health-related quality of life (HRQOL) among people with non–insulin-treated type 2 diabetes in primary care practice.

Design, Setting, and Participants The Monitor Trial study was a pragmatic, open-label randomized trial conducted in 15 primary care practices in central North Carolina. Participants were randomized between January 2014 and July 2015. Eligible patients with type 2 non–insulin-treated diabetes were: older than 30 years, established with a primary care physician at a participating practice, had glycemic control (hemoglobin A1c) levels higher than 6.5% but lower than 9.5% within the 6 months preceding screening, as obtained from the electronic medical record, and willing to comply with the results of random assignment into a study group. Of the 1032 assessed for eligibility, 450 were randomized.

Interventions No SMBG, once-daily SMBG, and once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered via the meter.

Main Outcomes and Measures Coprimary outcomes included hemoglobin A1c levels and HRQOL at 52 weeks.

Results A total of 450 patients were randomized and 418 (92.9%) completed the final visit. There were no significant differences in hemoglobin A1c levels across all 3 groups (P = .74; estimated adjusted mean hemoglobin A1c difference, SMBG with messaging vs no SMBG, −0.09%; 95% CI, −0.31% to 0.14%; SMBG vs no SMBG, −0.05%; 95% CI, −0.27% to 0.17%). There were also no significant differences found in HRQOL. There were no notable differences in key adverse events including hypoglycemia frequency, health care utilization, or insulin initiation.

Conclusions and Relevance In patients with non–insulin-treated type 2 diabetes, we observed no clinically or statistically significant differences at 1 year in glycemic control or HRQOL between patients who performed SMBG compared with those who did not perform SMBG. The addition of this type of tailored feedback provided through messaging via a meter did not provide any advantage in glycemic control.


4) Endocrine Society
Released October 16, 2013*

Avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.

Once target control is achieved and the results of self-monitoring become quite predictable, there is little gained in most individuals from repeatedly confirming. There are many exceptions, such as for acute illness, when new medications are added, when weight fluctuates significantly, when A1c targets drift off course and in individuals who need monitoring to maintain targets. Self-monitoring is beneficial as long as one is learning and adjusting therapy based on the result of the monitoring.


5) Cochrane Database Syst Rev. 2012 Jan 18;1:CD005060. doi: 10.1002/14651858.CD005060.pub3.
Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin.

Abstract

BACKGROUND:
Self-monitoring of blood glucose (SMBG) has been found to be effective for patients with type 1 diabetes and for patients with type 2 diabetes using insulin. There is much debate on the effectiveness of SMBG as a tool in the self-management for patients with type 2 diabetes who are not using insulin.

OBJECTIVES:
To assess the effects of SMBG in patients with type 2 diabetes mellitus who are not using insulin.

SEARCH METHODS:
Multiple electronic bibliographic and ongoing trial databases were searched supplemented with handsearches of references of retrieved articles (date of last search: 07 July 2011).

SELECTION CRITERIA:
Randomised controlled trials investigating the effects of SMBG compared with usual care, self-monitoring of urine glucose (SMUG) or both in patients with type 2 diabetes who where not using insulin. Studies that used glycosylated haemoglobin A(1c) (HbA(1c)) as primary outcome were eligible for inclusion.

DATA COLLECTION AND ANALYSIS:
Two authors independently extracted data from included studies and evaluated the studies' risk of bias. Data from the studies were compared to decide whether they were sufficiently homogeneous to pool in a meta-analysis. Primary outcomes were HbA(1c), health-related quality of life, well-being and patient satisfaction. Secondary outcomes were fasting plasma glucose level, hypoglycaemic episodes, morbidity, adverse effects and costs.

MAIN RESULTS:
Twelve randomised controlled trials were included and evaluated outcomes in 3259 randomised patients. Intervention duration ranged from 6 months (26 weeks) to 12 months (52 weeks). Nine trials compared SMBG with usual care without monitoring, one study compared SMBG with SMUG, one study was a three-armed trial comparing SMBG and SMUG with usual care and one study was a three-armed trial comparing less intensive SMBG and more intensive SMBG with a control group. Seven out of 11 studies had a low risk of bias for most indicators. Meta-analysis of studies including patients with a diabetes duration of one year or more showed a statistically significant SMBG induced decrease in HbA(1c) at up to six months follow-up (-0.3; 95% confidence interval (CI) -0.4 to -0.1; 2324 participants, nine trials), yet an overall statistically non-significant SMBG induced decrease was seen at 12 month follow-up (-0.1; 95% CI -0.3 to 0.04; 493 participants, two trials). Qualitative analysis of the effect of SMBG on well-being and quality of life showed no effect on patient satisfaction, general well-being or general health-related quality of life. Two trials reported costs of self-monitoring: One trial compared the costs of self-monitoring of blood glucose with self-monitoring of urine glucose based on nine measurements per week and with the prices in US dollars for self-monitoring in 1990. Authors concluded that total costs in the first year of self-monitoring of blood glucose, with the purchase of a reflectance meter were 12 times more expensive than self-monitoring of urine glucose ($481 or 361 EURO [11/2011 conversion] versus $40 or 30 EURO [11/2011 conversion]). Another trial reported a full economical evaluation of the costs and effects of self-monitoring. At the end of the trial, costs for the intervention were £89 (104 EURO [11/2011 conversion]) for standardized usual care (control group), £181 (212 EURO [11/2011 conversion]) for the less intensive self-monitoring group and £173 (203 EURO [11/2011 conversion]) for the more intensive self-monitoring group. Higher losses to follow-up in the more intensive self-monitoring group were responsible for the difference in costs, compared to the less intensive self-monitoring group.There were few data on the effects on other outcomes and these effects were not statistically significant. None of the studies reported data on morbidity.

AUTHORS' CONCLUSIONS:
From this review, we conclude that when diabetes duration is over one year, the overall effect of self-monitoring of blood glucose on glycaemic control in patients with type 2 diabetes who are not using insulin is small up to six months after initiation and subsides after 12 months. Furthermore, based on a best-evidence synthesis, there is no evidence that SMBG affects patient satisfaction, general well-being or general health-related quality of life. More research is needed to explore the psychological impact of SMBG and its impact on diabetes specific quality of life and well-being, as well as the impact of SMBG on hypoglycaemia and diabetic complications.



The FDA is currently reviewing and updating the guidelines for glucose meter accuracy and as of now, the new 2019 FDA drafted rules for personal use glucose meters will require:

95% within +/- 15% across the measuring range
99% within +/- 20% across the measuring range

These are not much different then the 2016 guidelines.

A 2018 study by The Diabetes Technology Society Blood Glucose System Surveillance Program, found that only 6 of the top 18 glucose meters met the accuracy standards.

You can see the study and the 6 here.

https://www.diabetestechnology.org/surveillance.shtml

Two main points

1) many of the most popular meters (67%) failed to meet the accuracy standards.

2) of those that do pass, they are allowed a variance of 20%.

So, if your BS reading was 100, that means that 95% of the time your true BS level was at the time of the test somewhere between 85 and 115. So 5% of the time it would be below 85 or above 115. However, 4 of those 5 reading, or 99% of the time, would still be within 80-120 at the time, assuming it was actually 100 when taken.


In regard to Continuous Glucose Monitors (CGM), about the same, which is not very good

See Table 1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501529/

Overall
⩾ 95% within ±15 mg/dl or ±15%(a)
>87% within ±20%

As above, there is some value for this in a type 1 but not recommended for a type 2

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Re: Blood sugar

Postby JeffN » Mon Jun 21, 2021 5:41 pm

This is from Dexcom’s website. They are discussing their CGM accuracy and talk about the 20% error rate (up and down).

https://www.dexcom.com/faqs/is-my-dexco ... r-accurate

Quoting…

“For example the orange highlighted row shows that if your meter value is 100 mg/dL, your G6 reading is a close match if it’s between 80 and 120 mg/dL.”


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