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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