Type 2 diabetics have an alternative

I was shocked and concerned by the article “Policy leaves patients poorer” (March 17), because of the appalling and unconstructive drain on a poor family’s finances as described in the story.

A weekly newspaper is not a usual place to debate medical issues, but your readership is such that I think it extremely important that the piece is countered. I write as a general practitioner who has had type 2 diabetes for 18 years.

All diabetics should maintain as normal a blood glucose level as possible to avoid long-term complications. To achieve that, type 1 diabetics depend on an appropriate diet and on insulin. Finger-prick testing is used several times a day to determine the appropriate dose. But insulin is so powerful that hypoglycaemia may occur.

Type 2 diabetics, also depending basically on the right kind of diet, take pills instead of insulin. Such tablets take their effect slowly compared with insulin.

Hypoglycaemia is rare for an experienced and well-managing type 2 diabetic. Its characteristic symptoms can be recognised, perhaps confirmed by a finger-prick test, and corrected by a standby supply of dextrose tablets. (They do not require an ambulance!)

For type 2 diabetics, trying to make sensible use of frequent one-off finger-prick tests is an extravagant, even confusing, way of monitoring progress. Moreover, done at a clinic it is of little value, even misleading, because you may not have eaten or might have been queuing for ages.

The best way to use such tests to gauge the combined effect of medication and diet is at home, over a few days and by recording the levels at particular times such as fasting (first thing in the morning and two hours after each meal). Showing it to your healthcare practitioner helps in your management. Also recording what you ate during those days allows for practical advice about diet, which is just as important as medication but harder to get right. As time goes by, such a test programme can be reduced to once every two or three months — a huge saving on test strips.

But the best way of all to monitor progress is the HbA1c test, which gives the average blood sugar level over about the past six weeks. The “Hb” comes from “haemoglobin”, because the level of sugar in our red blood cells is the result of the ups and downs in the blood they live in. How often this test needs to be done depends on how good the results are, and should be required less often, perhaps reduced to once in three months, perhaps even less.

I was shocked when a friend in Winterveld, outside Pretoria, was refused this test at her clinic and hospital.

With my concern for type 2 diabetics, I strongly believe that intermittent HbA1c testing should be generally available and, used with the management I have described, should be far more cost-effective for the government and individuals and should do away with the extravagance of “R600 per month” for finger-prick testing mentioned in the article.