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A1C or blood glucose monitoring: Which one is better? Neither. You need both measurements to ensure you have good diabetes management. First, let's look at the two and their differences.
The A1c test: The A1c test measures the amount of glucose on your red blood cells and gives an average of your blood glucose control over a period of 2-3 months. This test is generally ordered by your healthcare provider every 3-6 months, depending on your blood glucose control and the type of diabetes you have.
The goal standard set by the American Diabetes Association is for you to keep your A1c percentage at 7.0 or below. The American Association of Clinical Endocrinologists prefers the percentage to be 6.5 or below. The American Geriatrics Society recommends A1c levels of 7 percent or lower for healthy adults and less stringent levels for less healthy adults of 8 percent or lower.
Blood glucose metering: Checking your blood glucose with your personal meter gives you immediate information and helps you make decisions for your diabetes management. Metering helps you determine how to dose your insulin, handle exercise and illness, and tell you if you're on track with your diabetes care.
Even if you're not on insulin, blood glucose metering even several times a week tells you how well you're doing, if you need to make lifestyle changes, or if you need to contact your healthcare provider for help.
The two tests together inform your provider of the long range control over the past 2-3 months and the meter reading tells the day to day control. I sometimes use the analogy; the A1c is the motion picture and the blood glucose meter readings are the camera snap shot picture.
Meanwhile, Reuters Health recently reported that frequent blood sugar testing was strongly associated with better diabetes control in a large new study that concludes public and private insurers should not be limiting test strip supplies.
Nancy Klobassa Davidson, R.N.
Peggy Moreland, R.N.
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You indicated in the newsletter that a new study indicates that concludes public and private insurers should not be limiting test strip supplies. That is all well and good.
However,I would like people to know that Medicare has denied two claims for two RXs requiring 6 (six) strips each day when I was put on insulin. My Rx has been reduced to 4 strips each day.
This article says, to test the blood sugar post-meal. My doctor always told me to test before eating my meals. Who is right?
I do so agree with the Reuters study saying more strip testing is linked to better diabetes control. Thank you so much for the article. Now that I recently started testing 2x per day, I am much more in control of my A1C.
Definitely blood sugar testing several times a day is important to controlling your blood sugar. Often I am surprised when I see a high BS reading.
I monitor my blood glucose every day, but my fasting levels are always above 6.1, which my doctor thinks is high. They range usually from 6.3 to 7.0. If I then eat breakfast, even with some carbs, and take a 2-hour post meal reading, it's fine, usually around 6.3 or 6.4.
I worry about my fasting level, but other diabetics tell me not to. What do you think?
I HAVE TYPE 2 DIABETES AND WHILE I HAVE ENOUGH TEST STRIPS FOR TWO TEST PER DAY, I SOMETIMES DO THREE AS I SEEM TO HAVE
TESTS UNDER 70 AND A RARE OVER 200. I HAVE WEST NILE DISEASE; WHEN IT ACTS UP FROM A VERY MINOR INFECTION MY TESTS GO UP A LOT. THOSE DAYS I MAY USE THREE STRIPS. SURE WISH I DID NOT NEED TO WATCH SO CAREFULLY.
Whey are test strips so expensive I live in Thailand and the cost are $60 for 50 strips , So maybe you can under stand why only test once a Day Gavin Pretty.
I have been a diabetic type 2 since 2009. I have been on insulin since I was diagnosed with acute pancreatitis. I was taking Novolin 70/30 twice a day 20cc in morning/22cc before dinner and 16cc levemir before bed plus two metformin. Am now taking Victoza once a day 1.8cc. Blood sugar use to stay around 100 or less during the day but at night, blood sugar is high in the morning, sometimes being 180. Now blood sugar is around 110 during the day. My A1C is anywhere from 48 to 51. So what is going on so I can keep the night time sugar in limits. My doctor wants me to stay in the 80-100 range but can't get it down to that level. Help.
I too was told mainly to test pre-meal with occasional post-meal just to see how I'm doing. Testing before meals allows you to adjust what you eat (ie less carbs, etc) thus having an impact on the outcome.
I also notice the immediate effect of light exercise, even a walk after meals will lower the "spike" in my blood sugar, and the effect lasts much longer than a few hours. Exercising after every meal has allowed me (type 2 diabetic) to eat only 2 meals per day with low-carb snacks inbetween, thus helping me to lose weight.
All efforts to lower my wifes BS by increasing medication result in severe hypo. She in on insulin and medicaton her A1c is 8.6 but her blood pressure and cholesterol tests are normal. She has had diabtes 10 years and is 70. She exercises and follows strict diet. No complications yet
I went to refill strips for meter at CVS. They again tried to charge me 165. dollars. I carried on and after 2 visits and they ran my insurance and medicare properly, they were less than 5 dollars. I know I have paid the higher prices from them at another time. this needs to be addressed!!! What does medicare cover? i have been pre-diabetic and just started a once daily pill to help control sugar and am trying to test more often.
I checked with another pharmacy and I can buy the meter and strips without a prescription quite reasonably. so what is the story???
There are a number of important steps to good metering.
1. Wash off sunscreen/oils/etc. from finger tips.
2. Be sure to get circulation going, but don't do exercises and then test sugar. You want to try to cpature a 'normal reading'.
3. A1C isn't a perfect average, so if your meter readings are going up in the days before your A1C the result will be a 'high average', and the reverse seems to be that if your most recent meter readings are trending lower, your A1C will be lower.
There is some debate about agressive sugar control in seniors, (< 6.0) or < 120. What I am finding is that the lower the numbers, AF is less frequent. No research on this on so far.
I have trouible with high morning gloucose readings even with a low evening check; Any suggestions on how to lower morning readings.
I test 5-7 times a day. I've had type II for about 10 years and I use anywhere from 75 to 95 units of insulin per day, depending upon my intake and activity, plus I take 2500 mg of metformin. It is important to monitor both your blood glucose and A1C. I use an excel spread sheet to calculate my daily, 14 day and 90 day average. The spread sheet calculates my A1C on my 90 day daily average. I compare it to the the results at the doctor and add a fudge factor to the spread sheet A1C calculations. I have found that my BS spikes pretty high at night and starts falling before I get up. After a while of keeping track of daily results I can predict what foods impact my BS. Even topical ointments with steroids raise my blood sugar and I know how much insulin to adjust for that with my records. I work some shift work and have to adjust for that. Having the daily test records on hand on my desktop and smart phone I can try to out guess where my BS is going. All my computers talk to each other (sync)so I am always looking at the same excel file. I also enter a short symbol for my activity level, keep track of steps I take and note any abnormalities. I have no diabetes side effects.... yet!
Currently my insurance, Blue Cross and Blue Shield Fed. Employee Plan, limits the quantity of blood test strips that I am allowed to purchase. It is vexing to be out of strips and to be told that my insurance will not approve my strip purchase, "but I can pay out of pocket." I told the pharmacist that it made no sense that the insurance will not cover a product that is crucial to good blood sugar control. I am so glad to hear that there is a Reuters Health survey that concludes the same. Now if only the health insurance companies could understand.
High and low swings happen even if I do not eat. Trying the LCHF diet to help lower my high trigriclorides so I plan to stay on this for 6 months. Then have a blood lipid test to see the results. I have also began the app called the diabetes journal which tracks my BG gives me 7, 30, 60, day averages. My dr said look at the average do not focus on the high or low readings. My highs are 230 range my lows are usually in the 100's.
Any suggestions are welcomed.
I currently test twice per day but would test more often if my insurance company would cover the extra test strips.
I test 7 times per day. Because for me it is necessary to do this. Otherwise I will cheat. Testing frequency keeps me on the straight and narrow. I attribute my homeostasis to the frequency in testing. I take only exogenous insulin. In my case, it has shown to be a double edge sword. On one hand it delivers insulin needed. On the other hand, it makes me crave sweets. I now have devised a substitute to bring my cravings under control in most cases. Then again, cravings can become extremely strong. When I give into them and grab something sweet, I check my glucose levels and if they have risen, I immediately will start to exercise to bring it under control. Diabetes is a disease that requires constant monitoring. Truly difficult to deal with. But I must admit, it is very satisfying to know that my effort have not been in vain, when A-1c tests comes out perfect. You feel that you may have Diabetes, but Diabetes doesn't have you.
This was a great article! Very helpful information! Keep up the great work!
I am 72, male, have had diabetes for 10 years, weight 160, height 5'7", BMI 25.5. I check glucose level at least 2 times a day, usually just before meal, and don't eat until it is down to 100. Recent A1c is 6.1. I exercise and take only 500mg Metformin once a day.
Question: when to check post meal? two, three or four hours later?
I also wonder why my pre-diabetic wife age 65 shouldn't regulate her diet by linking intake to glucose level, like I do?
UK in Virginia
The above article states to test blood sugar post meal - my daughter's doctor states to test pre meal. I test her 4x's a day pre meal. Two of those testing times she is given medication then 30 minutes later another pill then she is to eat...so testing must be pre meal. Then again at bedtime before her insulin shot which has no meal. So I think it is based on the diabetic person's needs and the regime prescribed by the physician...right? I know some diabetics are testing before and after meals...My daughter's A1C's have been in the 7-8 range as her weight fluctuates based on the season with less activity & holidays which I know is not healthy: we are working on it. It is tough she is mentally and physically challenged - 2 years diagnosed so we are still learning and working on this new addition to our lives. Knowing it is a progressive disease is heartbreaking to me so I am truly trying to get it stable in numbers but it is really hard!
As someone who was diagnosed with type 2 diabetes about a year and a half ago, I have never understood why medicare has limited to supply of testing strips and lancets to one per day. It seems that this is a penny wise, pound foolish policy since treating the complications of uncontrolled diabetes is much more expensive than providing adequate testing supplies.
I typically test twice a day on average, and have sometimes supplemented the cost of supplies out of my own pocket. Based on the the daily test results, I was able to lower my A1C from 7.0 to 6.3 without medication, but with exercise and dietary changes. I am now taking metformin because I realized it has other advantages, but I also believe that if I limited myself to once a day testing, it would have been much more difficult for me to have achieved these results.
My doctor asks me to test pre-meal. The article says the opposite.
What are the issues?
Since I started relying on both methods to gain information my control has improved significantly. I test before and after meals and at bed time. That makes 7 times a day. I also test during exercise sessions and if I am experiencing any low sugar symptoms. The total test frequency is between 210 and 250 every month. My prescription is for 7 tests per day. I am hopeful that at my next Dr appt I can get the prescription changed upward to 250/mo.
Testing in my experience ensures better control and the peace of mind that comes with knowing you are doing the things necessary for good control.
My doctor really doesn't care about the meter readings. I have lots of swings for a type 2 diabetic even though my A1C is about 6.1 they don't seem to agree w/ regular lab results.
what can I do about diabete keto.
You stated the A1C goal standards.
Are there standards for glucose meter readings?
Thank you very much.This article has been very helpful to me.Since long I had been searching for a clear explanation about the diffrence between A1C and metering.
It is of little use to test the blood sugar at home if you don't use that information to change what and when you choose to eat and to encourage exercise. If you take it at the same time every day, it has not changed, and you are not willing to make a change in your eating or exercising that day, skip the test for several days and save!
my fasting numbers are high in the morning...then drop all day to about 115 before dinner (starting about 175 at 7 am)....what is that?
This is a great information. I enjoy learning more with every article. As a newly diagnosed diabetic in the last 6 months, I'm very thankful for your weekly updates!
I AGEE WITH YOUR COMMENT.
I AM A SENIOR OF NEARLY 85 YEARS AGE. I HAVE DIAB. TYPE 2. I TESTED SUGAR (FASTING ) EVERYDAY UNTIL TILL MARCH 1954. STRIPS WERE SUPPLIED NO CHARGE BUT NOW OLY LIMITED SUPPLY IS PROVIDED FREE OF CHARGE AND I CANNOT TEST FOR B.S. DAILY. I AM PUZZLED, WHICH IS COSTLY, PROVIDING FREE TREATMENT FOR DIAB. OR TRY TO PREVENT SERIOUS CONQUENCES FROM THE DESEASE ? I LIVE IN ONTARIO, CANADA , I HAVE PRIVETE MED. INSURANCE COVERAGE AS WELL AS IN ONTARIO MEDIALEXPENCES ARE SUPPOSED TO BE COVERED UNDER PROVINIAL INS. PLAN.
On the question'what if A1c and glucose readings don't match" The article does not providr the comparison numbers. What meter reading is equal to a A1c of 6 or 7 or 7.5?
my last AIC test in Feb 2014 was 5.7,the testing lab this was HIGH,my Doctor said they are NUTS,any comments?
Kern: "In future articles could you speak to the issue of using a Sliding Scale in insulin management!" Thank you for the topic suggestion. It is a good one and I will work on it. Always looking for topics of interest!
If you are not taking insulin, Medicare only allows you one test strip a day. I take metformin 2x a day. testing more often would probably prevent Type 2 patients from graduating to insulin. We need to push for the price of the strips to go down they have been around long enough that they should be generic. I usually test first thing in the morning.
Your article did not address what if your daily test is good and the A1C is 7.6. Which is an average of 170. Average daily test is only 130.
Mr. King should have the doctor write a Rx for the number of times testing per day. I test mine 4 time a day and have no problem getting the right amount of test strip from medicare.
I am a new subscriber to the news letter and I'm enjoying the information I'm getting! In future articles could you speak to the issue of using a Sliding Scale in insulin management!
Someone should tell Medicare about these finds they only allow for one test per day. I was testing 3times pr day and had to cut back to 1. This caused less accuracy in testing.
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