Last July (2014), the official publication of the American Diabetes Association (ADA), Diabetes Care, published a position paper written on behalf of the authors of the Type1 Diabetes Sourcebook. The title of the piece, Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association, reflects its comprehensive nature. It was written by Jane L. Chang, M. Sue Kirkman, Lori M.B. Laffel, and Anne L. Peters.
In this climate of Medicare and other payer cutbacks with blood glucose test strip allowances, this position is a breathe of fresh air. Here are their recommendations for frequency of blood glucose testing:
Patients with type 1 diabetes should perform SMBG [self monitoring of blood glucose] prior to meals and snacks, at a minimum, and at other times, including postprandially to assess insulin-to-carbohydrate ratios; at bedtime; midsleep; prior to, during, and/or after exercise; when they suspect low blood glucose; after treating low blood glucose until they have restored normoglycemia; when correcting a high blood glucose level; prior to critical tasks such as driving; and at more frequent intervals during illness or stress. (B)
Individuals with type 1 diabetes need to have unimpeded access to glucose test strips for blood glucose testing. Regardless of age, individuals may require 10 or more strips daily to monitor for hypoglycemia, assess insulin needs prior to eating, and determine if their blood glucose level is safe enough for overnight sleeping. (B)
These authors/doctors get it. There is abundant medical rationale to test at least ten times per day, sometimes more. I realize that not every T1D wants make room in her/his life for this frequency of checking but some of us do. I'm glad to see this position declared in black and white!
Now I know that this position paper only speaks to type 1 diabetes. I think that a similar position could be taken on behalf of people with T2D. Continual learning about the effects of different foods on post-prandial blood glucose requires lots of strips. Anyone that uses insulin faces the same challenges as the typical T1D.
So, the next time that some bean-counter payer pushes back on the number of test strips that you need, this is a great piece from which to cut and paste.
By the way, the Type 1 Diabetes Sourcebook target diabetes clinicians as its audience. It's interesting to note that this book was sponsored jointly by the ADA and the JDRF.