Until CGMs are more accessible for people with type 2 diabetes, glucometers are still an essential tool in the diabetes toolkit. Surprisingly, it can be common to not have a glucometer prescribed at diagnosis. (You may have breathed a sigh of relief if that happened to you!) On the other hand, frustration can mount if you’ve been asked to manage your diabetes without this tool. Prescribing a glucometer is not the right fit for everyone. However, for most folks, having one is still vital for successful diabetes management.
Why Glucose Monitoring Matters
Monitoring your blood glucose provides a feedback loop on how medication, physical activity, stress, eating patterns, etc. are impacting your blood sugar. In short, it’s difficult to know what’s working and what’s not working for diabetes management without measuring your glucose levels. Monitoring also has a safety factor—often a meter is the only way you can tell if your blood glucose levels are too low or too high.
Without a glucometer, you and your provider will only have your A1c to determine how well your treatment plan is working. An A1c only gives a general overview of how your blood sugars were over the previous three months, so you need to know what your A1c is and where it should be for well-managed diabetes. For most folks, that’s an A1c under 7%. You and your provider may decide to check your A1c more often (every 3 months vs every 6 months) if you don’t have a glucometer.
When to Push for a Glucometer
The downfall to not having a glucometer prescribed at diagnosis is that you and your provider may forget to define a time when it is the right fit. Certain scenarios can increase the need/urgency for a meter. For example:
- If you have a medical condition that makes your A1c less reliable (i.e. later stages of chronic kidney disease)
- If you’re having signs/symptoms of high or low blood glucose
- If you take medications for diabetes, especially ones that can cause lows
How to Get a Glucometer
Reach out to your provider and ask them when and how a meter will be prescribed for you. Don’t be afraid to revisit this conversation more than once! No insurance company should deny a glucose meter these days (though they may limit the number of strips they cover). If you need to, you can purchase a glucometer over-the-counter (without a prescription), but it will be an out-of-pocket cost. Walmart’s ReliOn brand is one of the cheapest on the market.
Getting a Meter Is Only Part of the Picture
You and your provider need to be in sync on what your glucose goals are, when to monitor, and how that information will change your treatment plan. Getting a monitoring device prescribed by your provider will help with this, and provide space for other conversations about overall diabetes management.
Monitoring Doesn’t Have to Be Overwhelming: 5 Tips to Help!
You may be thinking WHY would I ever pester my provider about a glucometer?? It sounds painful, like a lot of work, and scary (what if I check and my blood sugars are high?). It doesn’t have to be overwhelming. There are a lot of tips and tricks that can help you balance monitoring glucose and quality of life.
- Tip 1: Adjust the needle depth on your lancet device. Most lancet devices have a number scale on them (some have lines). The higher the number (or longer the line), the deeper the needle goes in. Start at a smaller number or line and work your way up if you’re having trouble getting blood. (Before you work your way up, read Tip 2!)
- Tip 2: Milk that finger! You may assume if you don’t see blood, your lancet didn’t go in deep enough. Often that’s not true. Try milking your finger, by starting back where your finger connects to your hand and squeezing up the finger towards the tip. Squeezing just the fingertip cuts off blood supply, so make sure you milk that finger from palm to tip!
- Tip 3: The data on your meter doesn’t define you. I hear comments all the time like, “I’m a bad diabetic,” when someone sees higher readings on their meter. You’re not a good or bad person based on your glucose results. The meter gives you data on what’s working and what’s not. It tells you how your body responds to events, medications, stress, etc. The goal is that this data will help you take a proactive role in your diabetes management. Don’t let it dictate how you see yourself. You’re a complex human being, and way more than blood glucose.
- Tip 4: Vary your glucose checks. Some insurance companies only allow one glucose check a day. Your provider may ask you to check only once a day. That doesn’t mean you’re stuck with checking at the same time each day. Check a before-meal glucose or a fasting glucose when you get up in the morning. You could also check two hours after the start of a meal to see how your body responds. For most people, glucose level goals are 80-130 mg/dL fasting (or before meals) and less than 180 mg/dL two hours after meals.
- Tip 5: Make it meaningful. Glucose monitoring is only helpful when it’s information you can use. Check before and after medication changes, or before and after exercise, or before and after meals. This is called paired monitoring— basically connecting your actions to glucose results. This can give you direction on changes to make for your diabetes (or actions to continue). If your monitoring doesn’t have meaning, it becomes just one more task in your already busy day. That means it’s more likely to be forgotten or disregarded. So don’t be afraid to try monitoring at new times or around new events.
Know the Symptoms of High and Low Blood Sugar
Everyone with diabetes should know the signs of high and low blood glucose (and what can cause those things to happen). Most folks with T2D don’t struggle with lows unless medication is involved. Common signs of low glucose are sweating, feeling panicked/anxious, feeling shaky, hungry, weak, sleepy/drowsy, or confused. Some people can pass out or have a seizure from a severely low blood sugar. High blood glucose levels are usually the biggest battle for folks with T2D. Common signs of high blood glucose are thirst, frequent urination, headache, fatigue (no energy!), blurred vision, and infections that are hard to treat or keep returning (for example, yeast infections). If you notice signs or symptoms of highs or lows, you need to contact your provider.
Beyond the Meter: Continuous Glucose Monitors
Continuous glucose monitors (CGMs) are devices worn on the body that give continuous blood sugar readings throughout the day and night. Up until recently, they were geared toward people with diabetes who use insulin.
Two new over-the-counter CGMs specifically for people with type 2 diabetes who don’t use insulin will be coming out before the end of this year: Dexcom’s Stelo and Abbott’s Libre Rio. Both devices will be available for purchase without a prescription and hopefully covered by insurance down the road.
CGMs are slowly becoming more accessible for people with type 2 diabetes, but they are still out of reach for many people due to cost and other factors. Until they’re more widely obtainable, it’s important for people with type 2 to monitor blood sugars with their home glucose meter.
What Else Helps with Diabetes Management?
Your diabetes self-care actions are important whether or not you have a glucose meter. Exercise, healthy eating habits, stress reduction, consistent medication routines, etc. —- these things can all improve your glucose levels, even if you can’t see it on a glucometer. Working with a CDCES (Certified Diabetes Care and Education Specialist) will help support your development of these self-care habits.
In Summary
There’s no sugarcoating it (no pun intended)— monitoring is vital to managing diabetes well. Seeing glucose levels improve after physical activity can be encouraging and may help you continue to stay active. Connecting blood glucose spikes to your Starbucks latte (sorry!) may change your eating/drinking patterns. If you’re on the fence about a diabetes medication, seeing its positive impact on your glucose levels may be the evidence you need to support taking it. Monitoring with meaning can be empowering. So get that meter, have those conversations, and take control of your diabetes!
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