Are Diabetics Testing Their Blood Sugar Too Much?
Aug 9, 2011
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
When I was working in a cafeteria dish room, my favorite part of the day was anything that got me out of the dish room. The dish room was hot, humid, loud and smelly. One highlite of the week was if we got to deliver coffee and cookies to one of the nearby offices. That Tuesday, Munna and I got the call. We put on clean aprons, loaded up a trolley with carafes of coffee and covered plates of cookies and wheeled off to building 400. After a long series of elevators and hallways, we reached the reception desk. As an extra bonus, there was a familiar face at the desk. My mother happened to be manning the desk that morning. So I said hi to my mom, asked her which room to put the coffee in and Munna and I returned to the drudgery of the dish room. That night, my mom couldnt wait to talk to me over dinner. One of her co-workers had seen Munna and I deliver the coffee and cookies and was just disgusted. The co-worker went on and on about how rude and disrespectful the two young men who delivered coffee had been. The co-worker thought a report should be filed. The co-worker thought it was a terrible insult that one of the apronned young men called Betty Shewfelt Mom. My mother turned to her co-worker and said, Thats because hes my son. Arent assumptions grand?
Have you ever wondered why Manitoba Health decides to pay for one drug and not another? Me too. Manitoba Health is not transparent about how or why they reach these decisions, or even exactly who makes them. I imagine a secret room with a bunch of shadowy figures sitting around a table. These Drug Czars must discuss if a new drug works, how expensive it is and whether or not their political masters have said payment for this drug is a priority. One thing I do know about this shadowy group of Drug Czars is that they do accept recommendations from some outside authorities. One of the groups that gets to make recommendations to the Drug Czars is called CADTH. CADTH stands for the Candian Agency for Drugs and Technologies in Health. CADTH is a national organization that writes reports for health care decision-makers. They aim to give impartial, evidence-based information not just if a drug or technology works but if it is worth the cost. So, whether or not the Drug Czars decide to pay for a new drug might rest on a report from CADTH.
Because of the potential impact of CADTH reports, back in April I was very excited to go to a talk by someone from CADTH. Denis Belanger from CADTH gave a good talk that covered a lot of issues, but one of his case studies was very interesting and a little scary. CADTH has looked at how much people with diabetes check their blood sugar. CADTH says that inManitobadiabetics who just take pills for diabetes, not insulin, spend about $5.7 million a year on blood sugar strips. That $5.7 million is 42% of all the blood sugar strips bought inManitobain a year. Since many diabetics inManitobaget their strips paid for by Pharmacare, that is a lot of money coming out of Manitoba Health. In all ofCanada, CADTH estimates diabetics on pills only spend $450 million a year on blood sugar strips. CADTH wrote this report because acrossCanadaa lot of diabetics have their strips paid for by insurance companies, or provincial programs like Pharmacare. CADTH doesnt think diabetics on pills only should test their blood sugar any more than twice a week. CADTH says that if their recommendations were followed it would save provincial programs like Pharmacare and insurance companies $150 million dollars a year acrossCanada.
I was shocked when I heard Denis Belanger from CADTH says diabetics on pills only should either not test their sugars at all, or at most twice per week. He is a pharmacist by training. He worked in a hospital pharmacy for years before moving to CADTH. I thought he should know better. I thought he should know I tell people to check their sugars up to 2-3 times a day on occasion. I know the Diabetes Educators and the family doctors might even have someone check their sugars up to 5-8 times a day for a short while. But CADTH has some evidence on its side. When the people from CADTH checked the studies, there is very little evidence of benefit for diabetics on pills only to test their blood sugar. That means in studies diabetics on pills only who test their blood sugar often dont have any fewer diabetic complications, dont have any better quality of life or dont die any less often than diabetics on pills only who dont check their sugars. CADTH also pointed out that even when people bring their blood sugar logs into their doctors appointments, the doctors rarely look at them. The doctors tend to rely on the HbA1c numbers to adjust the patients medications.
There are exceptions to CADTHs no blood sugar testing rules. CADTH says people with Type 1 diabetes on insulin should test their sugars. CADTH says adults with Type 2 diabetes who use insulin could test their sugar twice a day.
I still think I disagree with CADTH. I think they are making too many assumptions. Im not sure if the lack of evidence of blood sugar testing benefits is because blood sugar testing is bad. I think maybe we just need a sugar strip manufacturer to pay for a large double blind placebo controlled trial to get the evidence. Also, in my experience, people who check their blood sugars are more involved in their own diabetes care. They get immediate feedback about if what they just ate makes their sugar go up a lot or a little. They get to find out if that 30 minute walk drives down their sugar more than sitting on the couch watching TV. Telling a diabetic to control their blood sugar but not letting them test it is like telling someone to diet and lose weight but not letting them go on a scale to see how they are doing. Finally saying that doctors dont look at the patients blood sugar results so patients shouldnt test is silly. Maybe we can just explain to the doctors how important those logs really are.
We all make assumptions everyday. But we all have to be careful about our assumptions. That 19 year old kid might not be insulting that 45 year old lady. He might just be calling her Mom because she is his mother.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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CADTH website: www.cadth.ca