To Stick or Not to Stick

To Stick or Not to Stick

Julian Whitaker, MD

For patients with diabetes, nothing is more common than the ubiquitous self-monitoring of blood sugar. Finger-stick testing makes sense for people with type 1 diabetes, as it plays a role in determining the amount and timing of insulin injections. But, in my opinion, for the overwhelming majority—those with type 2 noninsulin-dependent diabetes—daily finger sticks are a waste of time and money.

Every week at our new-patient orientation at the clinic, I ask everyone who has adult-onset, obesity-related diabetes if they do routine finger-stick testing. Almost all of them do. I then ask them what they do if their blood sugar is too high or too low, and in neither case is there any consistent action—other than to worry. They don’t increase their oral drugs. They don’t even alter their insulin (which a quarter of type 2s are on). All they do is kvetch about it!

In other words, these folks—and tens of millions of others—religiously stick their fingers every day to get readings that trigger no activity on their part. When I ask why, they say, “Well, my doctor tells me to.” But physicians don’t pay any attention to finger-stick readings either. They focus on hemoglobin A1C, a test that gives the average blood sugar over a six-to-eight week period. If the A1C is going up, we intensify our therapy. If it’s going down, we’re happy. If it stays the same, there’s less cause for concern. Finger-stick measurements are superfluous. Nevertheless, it doesn’t seem to enter the minds of physicians or patients to question this expensive and often painful practice. It’s just plain silly.

But there is a way to put this popular test to good use.

Test, Exercise, Test Again

At the clinic, we encourage our patients with type 2 diabetes to continue their finger sticks. However, we give them a specific course of action to take if their blood sugar is high: Go for a walk.

Exercise is like insulin in its ability to lower the blood sugar level, and lower it fast. When you’re in a resting state, the large muscles of your body require insulin in order for glucose to enter the cells. If those muscles are exercising, however, glucose and other nutrients can enter the muscle even in the absence of insulin. This is a well-known but little-used method of lowering blood sugar, and it is ideal for individuals with type 2 diabetes.

For instance, if a patient does a finger stick and his blood sugar level is 280—substantially higher than he would like—he should simply walk for about a half hour, wait another hour, and repeat the finger stick. More often than not, he will see a dramatic drop, sometimes below 200. That’s how powerful a therapy exercise is.

We have patients record their initial blood sugars, the type and duration of physical activity, and the results of their repeat finger stick test an hour after exercising. Not only does this give them something to do in response to a high blood sugar level, but it promotes a course of action that substantially improves diabetes control. Used in this way, self-monitoring becomes a tool for engendering therapeutic activity, not a painful, expensive waste of time.

Cut Costs, Improve Health

Unfortunately, outside of Whitaker Wellness finger sticks are rarely, if ever, utilized in a constructive manner. Nevertheless, the practice persists, despite dozens of scientific studies showing that routine self-monitoring does not improve blood sugar control. Instead, it drives up health care costs and is actually associated with poorer quality of life and higher risk of depression.

It’s easy to figure out why: just follow the money. Glucose meters cost around $75, although they’re usually heavily discounted and, in some cases, provided free of charge. Test strips, however, which cost pennies to make, have a price tag of up to $1 apiece, and many patients test several times a day. That’s a multibillion-dollar windfall for medical device companies.

According to studies published in the British Medical Journal, blood sugar test strips are the single largest expenditure in diabetes management in the UK. And Canadian researchers report that from a price perspective, they’re in the top three to five categories, outpacing all oral diabetes drugs combined! Furthermore, the bulk of these test strips are used by people with noninsulin-dependent type 2 diabetes—precisely the type of patient who benefits the least, or not at all unless they do something (i.e., exercise) to lower high readings.

I hope you’ll pay attention to this information and pass it on to others, for this seldom-used therapy is as powerful as any oral diabetes drug. If a finger stick test reveals a high blood sugar level, take a walk, retest, and see for yourself the tremendous role exercise plays in the management of diabetes.

Recommendation

  • If you need extra help getting your blood sugar under control and would like to make an appointment at the Whitaker Wellness Institute, please call (866) 944-8253.

References

  • Simon J, et al. Cost effectiveness of self monitoring of blood glucose in patients with non-insulin treated type 2 diabetes: economic evaluation of data from the DiGEM trial. BMJ. 2008 May 24;336(7654):1177-1180.
  • Cameron C, et al. Cost-effectiveness of self-monitoring of blood glucose in patients with type 2 diabetes mellitus managed without insulin. CMAJ. 2010 Jan 12;182(1):28-34.

Modified from Health & Healing with permission from Healthy Directions, LLC. Photocopying, reproduction, or quotation strictly prohibited without written permission from the publisher. To subscribe to Health & Healing, click here.

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