April 10, 2012

The Importance of SMBG for Type 2 - The Basics

Self-monitoring of blood glucose (SMBG) is important for people with all types of diabetes; however, I want to cover this for type 2. Just recording the results of your blood glucose readings in a log or journal gives you much information about your health. This recording of your blood glucose levels gives you visual evidence of your diabetes and how you are managing it. It also means that you are looking for ways to manage diabetes more effectively.

SMBG is an important task manager and a constant reminder on a daily basis of your goal for effective diabetes management. SMBG does require knowledge of what you are doing and the reasons for doing this important task. Some physicians will assist in encouraging you to test regularly and others could care less as all they want to see is the HbA1c (A1c) results as this gives them a three-month look back at how you are managing your diabetes.

We as patients also need the A1c results as this will give us information needed for adjusting our testing routines and it will tell us if we are doing it correctly. A good calculator for converting the A1c to average blood glucose readings is found here. If you use this and compare your average readings, you will be able to see how well, or not, you are managing your blood glucose. This will let you know if you are managing to prevent the spikes in your blood glucose. If not then you know that you have work to do to adjust when you are testing your blood glucose and that you need to work on managing what you are eating.

The purpose or goal of SMBG is to collect information about blood glucose levels at different times during the day to assist you in creating a more level blood glucose. You will use this information to adjust your regimen in response to the blood glucose values. This will mean adjusting your food intake, physical activity, and possibly medications with your doctor’s direction.

SMBG can aid in diabetes control by:
  • facilitating the development of an individualized blood glucose profile, which can then assist health care professionals in treatment planning for an individualized diabetic regimen;
  • giving people with diabetes, and their families, the ability to make appropriate day-to-day treatment choices in diet and physical activity as well as in insulin, oral agents, and even no medication;
  • improving patients’ recognition of hypoglycemia or severe hyperglycemia; and
  • enhancing patient education and patient empowerment regarding the effects of lifestyle and pharmaceutical intervention on glycemic control.

Patients properly educated and with some experience with SMBG can benefit from the empowerment that SMBG bestows. Diabetes specialists believe that patients should use the SMBG data for daily regimen changes and health care professionals should use SMBG data to guide changes in medication regimens.

The use and frequency of SMBG is the area of much disagreement among the various specialists and advocates of SMBG. From my prospective, I feel it will depend on what your budget allows and insurance will cover. With all that is happening with studies it is surprising we still have testing supplies. Some doctors will not even give prescriptions for testing supplies and others will delay this until the patient insists. Most insurances will cover a meter and test strips up to what Medicare allows for the type of diabetes you have and the medication you are taking. SMBG is the battleground for all people that need testing supplies. Medicare restricts testing supplies and most insurance companies follow in lock step.

If you are able to afford additional testing supplies, by all means, make good use of them. Shortly after diagnosis, you need to use your meter to determine how different foods affect you blood glucose. This will assist you in knowing which foods to decrease in quantity, which to eliminate from the menu for now and which are safe to continue eating. Most people that are conscientious about their testing and realize that readings are trending upward will want to retest their foods again and find out what is changing.

We all need to understand the reasons for doing certain tasks and the more we understand about self-monitoring of blood glucose, the more effectively we will use it. I am not in agreement with the current trend in testing for people with type 2 diabetes. The powers that be just do not allow for proper testing or frequency of testing needed to cover periods when your body chemistry may change, for determining what foods do for your blood glucose levels, whether an illness is affecting your blood glucose, or if a medication, especially steroids, is driving your blood glucose above normal levels. These are concerns all insurance companies do not even allow for. Even our medical community shows little interest in this and will deem you to be not watching your blood glucose when your A1c rises unreasonably.

For patients with type 2 diabetes, optimal SMBG frequency varies depending on the pharmaceutical regimen and whether patients are in an adjustment phase or at their target for glycemic control. If a patient is on a stable oral regimen with A1c concentration within the target range, specialists recommend infrequent SMBG monitoring. In such cases, patients can use SMBG data as biofeedback at times of increased stress or changes in diet or physical activity.

Finally, the following steps should be part of your guidelines for testing blood sugar levels; you should get specific details for your blood glucose monitors from the package insert or your healthcare provider. Never share blood glucose monitoring equipment or fingerstick lancing devices. Sharing of this equipment could result in transmission of infection, such as hepatitis B.
  • Wash hands carefully with soap and warm water paying attention to the finger you will use, and thoroughly dry your hands.
  • Prepare the lancing device by inserting a fresh lancet. Lancets that are used more than once are not as sharp as a new lancet, and can cause more pain and injury to the skin. This is the recommendation from the manufacturers, but I change mine only once a month or when testing on my wife's finger.
  • Prepare the blood glucose meter and test strip (instructions for this depend upon the type of glucose meter used).
  • Use the lancing device to obtain a small drop of blood from your fingertip or alternate site (like the skin of the forearm). Alternate sites are often less painful than the fingertip. However, results from alternate sites are not as accurate as fingertip samples when the blood glucose is rising or falling rapidly. Actually they can be approximately 20 minutes behind the levels obtained from your fingertips. This is not good when blood glucose levels are falling rapidly.
  • Apply the blood drop to the test strip in the blood glucose meter. The results will be displayed on the meter after several seconds.
  • Dispose of the used lancet in a puncture-resistant sharps container (not in household trash). Sharps containers may be obtained from your local pharmacy and occasionally you may need to wait a few days to allow them to receive a new order.

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