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Self-Monitoring of Blood Glucose in Diabetes

A tree in Maui. (Dr. Noorali Bharwani)
A tree in Maui. (Dr. Noorali Bharwani)

Diabetes mellitus or simply called diabetes is a chronic, lifelong condition that affects our body’s ability to use the energy found in food. This happens when our body’s capacity to produce insulin is diminished.

There are two types of diabetes – not counting gestational diabetes that occurs during pregnancy.

Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. Only five per cent of people with diabetes have this form of the disease. The body is not capable of producing insulin.

Type 2 diabetes is the most common form of diabetes. In this situation the body produces insulin but the body does not use insulin properly. Eventually, the pancreas that normally produces insulin fails.

Individuals with diabetes have to check the blood sugar levels regularly to make sure it is within normal range. If the levels are too high then it can cause many complications. Instead of going to a lab for blood tests diabetic patients can now do their own blood tests and adjust their own insulin dosage.

Consumer Report (Blood Glucose Meter Buying Guide) says today’s blood glucose meters are smaller, faster, and come with more features than ever before. They’re also more accurate than blood glucose meters of years past. That’s good news for approximately 30 million North Americans with diabetes.

Why is it so important for diabetics to monitor their blood sugar levels?

Controlling blood glucose is key to managing diabetes and preventing complications. Test results help patients make adjustments to their diet, exercise routine, and diabetes treatment plan, which can help lower the risk of seizures, blindness, kidney disease, and nerve damage. There are dozens of models available priced between $10 and $75.

The Consumer Report warns don’t just look at the retail price of the meters alone. What makes blood glucose monitoring expensive is the test strips that you might use many times a day. At $18 to $184 per 100 test strips, the cost can add up to about $265 to $2,685 a year for people who test four times a day. Also there is a learning curve to make sure you get a full value for your health and investment.

Does regular monitoring of your blood sugar make your health better?

Xiang and colleagues (Journal of Diabetes Science and Technology, July 2014) says the blood glucose meter is the most successful and widely used portable device for point-of-care tests. The device has more than 50 years of technology development. So the device has stood the test of time. Regular self-monitoring of blood glucose levels in diabetics play a key role in preventing complications in the short, medium and long term.

How do you decide which meter to buy?

One way is to ask your friends who have similar health issues. Ask your doctor, nurse, dietician or individuals who work in diabetic clinics. See what the Consumer Reports has to say. Experts at their National Testing and Research Center tested 25 models to see which ones perform best.

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Doctors advised to treat elderly carefully with cholesterol-lowering drugs (statins).

Dubai, United Arab Emirates. (Dr. Noorali Bharwani)
Dubai, United Arab Emirates. (Dr. Noorali Bharwani)

The College of Physicians and Surgeons of Alberta in their newsletter, The Messenger (Jan 11 2017) advised doctors to use statins carefully in the elderly.

If your blood cholesterol level is high then you should ask your doctor if treatment with statins is right for you.

High cholesterol level is a risk factor for heart disease. Statins are drugs that can lower cholesterol level in your blood. If your blood cholesterol level is high then plaques build up on the blood vessel walls. This causes partial or complete blockage of the blood vessels and reduces or blocks blood circulation. Why would you want that to happen?

Statin drugs are commonly used to reduce blood cholesterol level. Examples of statins include – atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

Statin is effective in lowering the cholesterol level. It may have other health benefits but we do not know everything about it. What is the effect of statin in the elderly is not very well known either. There is a variable quantity of data related to statin use in the elderly, according to the Canadian Cardiovascular Society Guidelines (2016).

The 2016 guidelines continue to recommend treatment for individuals at high risk for cardio-vascular events. This is with the caveat that for adults older than age 75 who are otherwise robust, a discussion should take place regarding the risks and benefits in the context of their individual situation. As I said earlier we do not have much information on the side effects of statin in individuals over the age of 75.

What are the side effects of statin use?

The most common adverse events (1.3 per cent) identified include musculoskeletal events (aches and pains in the muscles) and elevation in liver enzymes. Although not statistically significant, there may be new-onset diabetes and cataract formation. Doctors should monitor their patients for cognitive impairment as well, as it may be associated with statin use.

If you have been on statin prior to age 65, then you can continue to take it after that age if you have had no side effects. Make sure you discuss this with your doctor. You should try to keep total cholesterol level below 6.22 mmol/L. LDL or “bad” cholesterol should be below 3.37 mmol/L.

Taking a statin is one thing but you have to remember lifestyle changes are essential for reducing your risk of heart disease, whether you take a statin or not.

To reduce your risk: 1. Quit smoking and avoid second hand smoke. 2. Eat a healthy diet that’s low in saturated fat, trans fat, refined carbohydrates and salt, and rich in fruits, vegetables, fish, and whole grains. 3. Be physically active, sit less and exercise regularly. 4. Maintain a healthy waist girth: less than 40 inches in men and less than 35 inches in women.

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The significance of expiry dates on medicine and food.

Franklin Delano Roosevelt Memorial in Washington, DC. (Dr. Noorali Bharwani)
Franklin Delano Roosevelt Memorial in Washington, DC. (Dr. Noorali Bharwani)

In the Medical Post (November 25, 2003) Dr. Maria Hugi wrote a column titled, “Drugs still effective long past their expiry dates.” Dr. Hugi is an emergency physician in Vancouver. She was using the information obtained from an article in the Medical Letter (October 28, 2002).

The Medical Letter article says drugs stored without exposure to humidity (stored at a dry room temperature) probably retain 90 per cent efficacy five years after the expiration date if not much longer.

What does U.S. Food and Drug Administration (FDA) web site say?

It says expiration date matters. If your medicine has expired, it may not provide the treatment you need. Expiration dates help determine if medicine is safe to use and will work as intended.

According to Wikipedia, shelf life is defined as the length of time that a commodity may be stored without becoming unfit for use, consumption, or sale. Most expiration dates are used as guidelines based on normal and expected handling and exposure to temperature.

The Canadian Food Inspection Agency produces a Guide to Food Labelling and Advertising that sets out a “Durable Life Date”. The authority for producing the guide comes from the Food and Drugs Act. The guide sets out what items must be labelled and the format of the date.

Harvard Health Publications (HHP) asks, “Drug Expiration Dates – Do They Mean Anything?”

Since a law was passed in the U.S. in 1979, drug manufacturers are required to stamp an expiration date on their products. This is the date at which the manufacturer can still guarantee the full potency and safety of the drug.

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military.

What they found from the study is 90 per cent of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.

So the expiration date does not really indicate a point at which the medication is no longer effective or has become unsafe to use. Medical authorities state expired drugs are safe to take, even those that expired years ago, says the article in the Harvard Health Publications (HHP).

What are the exceptions to the rule?

Excluding nitroglycerin, insulin, and liquid antibiotics, most medications are as long lasting as the ones tested by the military. Place medication in a cool place, such as a refrigerator, will help a drug remain potent for many years, says HHP.

So the expiration date doesn’t really indicate a point at which the medication is no longer effective or has become unsafe to use. There is relatively little scientific data about out-dated medications. What you see on the drug and food packages is a guideline. Use the guideline smartly. If in doubt talk to your pharmacist or food store.

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The thyroid gland has an enormous impact on your health.

Lake Louise, Alberta. (Dr. Noorali Bharwani)
Lake Louise, Alberta. (Dr. Noorali Bharwani)

In my last column we discussed the management of a thyroid tumour. Today, we will discuss another aspect of thyroid disease: under active (hypo-thyroid) and over active (hyper-thyroid) thyroid gland.

It is estimated thyroid disorders affect one in 20 Canadians and most thyroid disorders are five to seven times more common in women.

Thyroid hormones are produced in the thyroid gland from iodine and an amino acid, tyrosine. The normal function of the thyroid gland is to produce and secrete hormones. There are two hormones which are closely related: T3 (triiodothyronine) and T4 (thyroxine).

These hormones have enormous impact on our health, affecting all aspects of our metabolism. They maintain the rate at which our body uses fats and carbohydrates, help control our body temperature, influence our heart rate, and help regulate the production of protein. These hormones are important for normal growth and development of children.

Hypothyroidism

Hypothyroidism causes many symptoms: weight gain, lethargy, cold intolerance, menstrual irregularities, depression, constipation, and dry skin. Deficiency of thyroid hormones in children leads to dwarfism and mental retardation.

There are many causes of hypothyroidism. Thyroid function can be diminished due to congenital development defect or acquired conditions like radiation therapy or autoimmune disease (Hashimotos’ disease).

Hashimoto’s disease is a condition in which your immune system attacks your thyroid. Inflammation from Hashimoto’s disease, also known as chronic lymphocytic thyroiditis, often leads to hypothyroidism. Hashimoto’s disease is the most common cause of hypothyroidism in North America. It primarily affects middle-aged women but also can occur in men and women of any age and in children.

Thyroid function is tested to help detect Hashimoto’s disease. Treatment of Hashimoto’s disease with thyroid hormone replacement usually is simple and effective.

Good news is accurate thyroid function tests are available to diagnose hypothyroidism. Treatment of hypothyroidism with synthetic thyroid hormone is usually simple, safe and effective. Finding an adequate replacement dosage of thyroid may take a little time.

Hyperthyroidism

On the other hand hyperthyroidism is not that easy to manage.

Clinically, hyperthyroidism presents with palpitations, nervousness, tremor, heat intolerance, weight loss, muscular weakness and quite often there is goitre.

Hyperthyroid gland can cause Graves’ disease that accounts for at least 90 per cent of all patients with hyperthyroidism. But the cause of hyperthyroidism is not very clear.

Graves’ disease is a condition where eyes are affected. It is called exophthalmos – protrusion of the eyeballs. Graves’ disease is an autoimmune disorder in which antibodies produced by your immune system stimulate your thyroid to produce too much thyroid hormone.

It is not clear what causes Graves’ disease, although several factors, including a genetic predisposition, are likely involved.

Unfortunately, there is no satisfactory treatment to prevent Graves’ eye disease. Because hyperthyroidism seems to affect the eyes, it is very important to treat hyperthyroidism quickly and effectively. In most patients, the eyes tend to get somewhat better when the thyroid abnormality has been treated.

Patients who are hyperthyroid are often treated with radioactive iodine or anti-thyroid medications to reduce and normalize thyroid function. However, in some cases, treatment of hyperthyroidism can result in permanent hypothyroidism.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!