Blood Sugar Testing in Diabetes

I get asked all the time about how frequently a diabetic should test his/her sugar. The answer is that it depends on how bad the diabetes is, and by extension if the diabetic takes insulin. If a diabetic is on insulin then, blood sugar testing at home using the glucometer may be necessary–especially if the rapid-acting insulins are used. I put my patients on the basal insulins, which rarely cause hypoglycemia (low blood sugar), and hence I don’t have them do daily blood sugars at home. (Some physicians have their patients test one or more times per day–I will not advise anyone to change their testing regimens without consulting their physicians–I am only telling you what I do.)
The argument might be made that tight control of blood sugar is necessary to prevent the complications of diabetes. That concept was disproven last year with three MAJOR trials that revealed that not only was tight control of blood sugar not beneficial to the cardiovascular consequences of diabetes and overall mortality, but in the ACCORD trial overall mortality was actually increased in the tight control group. So why test on a daily basis?
I have been treating diabetics for over 40 years. The only cases of significant retinopathy occurred over 25 years ago in a couple who paid no attention to diet and exercise, simply injected their insulin and went on their merry ways. Some of my diabetic patients have developed some minor retinopathy, but these are patients who were treated by endocrinologists in Toledo or refused treatment. No diabetic patient whom I have treated from the start has developed dialysis-worthy renal failure. I don’t say that no diabetic has ever developed renal failure, because some have–so have some non-diabetics. However, the only diabetics patients of mine who have required dialysis are those whom I inherited from other physicians.
I have published a letter to the editor of the American Journal of Cardiology and made presentations at various national and international symposia to show that prediction of the population at risk of atherothrombotic disease (ATD) is independent of blood sugar level. My diabetics who have never smoked cigarettes die, on average, later in life than the general population.
I follow my diabetics using a fasting and two-hour postprandial blood sugar level. I do not urine tests for microalbuminuria–it would not change my course of therapy, so why order the test? I believe that my results speak for themselves.

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