Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.
Dear Doctor: My family has a history of diabetes, and although I’m currently healthy (I exercise regularly and am careful about what I eat), I’m still curious about my blood sugar. Do you think it could be helpful to track it as a diabetic would, just so that I know how I’m doing?
Dear Reader: You’ve asked an interesting question about a growing practice among some non-diabetics. Diabetes is a group of diseases in which hyperglycemia — that’s elevated blood sugar — results from disruptions to the body’s insulin metabolism. Produced by the pancreas, insulin is the hormone that regulates blood glucose concentrations. People with diabetes either don’t produce any or enough insulin, or can’t properly use the insulin their bodies do produce. The cause of abnormal insulin metabolism determines which type of diabetes someone has.
This inability to manage blood glucose leads to levels that are abnormally high or low, each of which is dangerous. Low blood sugar can cause a rapid heartbeat, dizziness and heart palpitations. When severe, it can lead to seizures, unconsciousness and even death. When blood sugar levels are chronically high, there is risk of long-term damage to blood vessels, heart, kidneys, eyes and feet.
Managing blood sugar fluctuations is the goal of diabetes treatments. Depending on the type of diabetes that an individual has, this is achieved with diet alone, or through diet and insulin replacement. People are considered to have diabetes when a random blood sugar test measures above 200 mg/dL, or when they have a fasting blood sugar level of over 125 mg/dL. A fasting blood sugar level from 100 to 125 mg/dL is considered to be pre-diabetes.
All of which brings us back to your question. Regular blood sugar checks are crucial for people living with diabetes. Those with Type 1 diabetes use insulin and may need to test anywhere from four to 10 times daily. Type 2 diabetes can require two to three checks per day. And while we understand the impulse behind a non-diabetic wishing to track blood sugar, we don’t see a clear benefit. The argument in favor is that, with routine monitoring, you’ll learn how your body responds to specific foods, which may motivate you to make better dietary choices. Over time, however, the data will confirm what you already know. That is, complex carbs and foods high in protein don’t cause the same spikes in blood sugar that you get from refined carbs.
The truth is that glucometers and testing supplies can be costly. A single test strip costs $1. Without a diabetes diagnosis, these are unlikely to be covered by insurance. The same goes for the new continuous glucose monitoring systems, which work via subcutaneous probes that test interstitial fluids. In our practices, diabetic patients already have a challenging time dealing with insurance coverage. We doubt whether insurance would cover the expense for a non-diabetic.
Instead, we think it would be wisest to continue on your current course, with exercise, good dietary habits and regular screenings with your family doctor. Be sure he or she knows about your family history of diabetes, as well as your concerns about developing the disease.
