April 11, 2012

The Importance of SMBG for Type 2 - Beyond the Basics

If you have diabetes, you have responsibility in your medical care. The role means self-monitoring of blood glucose to manage the health you have. I find that managing diabetes is challenging. It can be a burden, but only if you let it. There are enough challenges to keep a person reaching for that higher level of diabetes management. One thing for all of us to remember is the importance of a positive attitude. This will generally help us through the tough times and keep us motivated to stay on top of our efforts to manage our diabetes.

With type 2 diabetes, our care may be sporadic from our health care providers and since they do not live with us 24/7, it is urgent that we learn how to care for ourselves. Is this easy at the start? I would be lying to myself and to you if I said it was, because there are many things to learn. It does get easier and at the same time more frustrating as we learn more about diabetes and its idiosyncrasies. We have to learn how to manage diabetes without assistance on many fronts.

Diabetes is termed a chronic condition for many reasons. This aside, we can usually manage diabetes by changing the way we live. This means exercise, if we are medically able, changes in diet, getting rid of bad habits, and other changes that I discuss here. The main goal is to maintain blood glucose levels in or at a near-normal range and the only way this is possible is with testing.

Each of us may have different testing objectives and testing times depending on how we manage our diabetes. In the early stages, it is for knowledge of how different foods affect our individual blood glucose levels. Once this has been established, we need to realize that our bodies change and foods that were taken off the list may be added back in small quantities and other foods may need to be taken off the menu. We need to test when we are ill and our blood glucose may fluctuate rapidly, or not, depending on the illness.

Many people have serious blood glucose problems when undergoing an operation or having problems with pain. If a doctor suggests a steroid shot, be prepared to discuss this as steroids tend to drive blood glucose levels upward dramatically and make their management very difficult. Sometimes the treatment is necessary and a discussion needs to take place with your diabetes doctor about the temporary use of insulin to manage your blood glucose levels during this period of steroid treatment.

Your doctor will periodically order a laboratory blood test to determine your blood glucose level and hemoglobin A1c test. The A1c is an approximate three-month look back at your blood glucose levels. This is the test doctors rely on to determine how you are managing your diabetes. This is why you need to monitor your own blood glucose levels on a daily basis.

For those of us with type 2 diabetes, testing is based on individual factors. These factors are the type of treatment (diet versus oral medication versus insulin), A1c, and treatment goals. Some doctors will be able to help you determine how frequently to test and others will rely on a certified diabetes educator (CDE) to assist you. Unless you have a very knowledgeable doctor, learn on your own and read what others have to say. Self-monitoring of blood glucose is not a one-size-fits-all regimen.

There are many other factors that should affect when and how you test your blood glucose levels. I have covered some of them in the past, but I recommend you reading this blog by Jenny Ruhl. Then follow this link to more information. I suggest starting in the second row of icons and the middle icon. This is a very excellent discussion on some of the reasons for testing.

Blood glucose meters today are reasonably accurate. There can be some variability from one unit to the next, so it is wise to exercise caution and common sense when using the readings from these devices. As an example, if a reading does not fit with your symptoms (or lack of symptoms), take a second reading or use an alternate method for testing your blood sugar (such as a different meter). Blood glucose meters are least accurate during episodes of low blood sugar. Be sure that if a meter reading is out of range that you think is right, do a rewash of your hands with warm water and soap and dry thoroughly. Then go through the retest.

We cannot leave this topic without emphasizing changes that need to be made. I have them laid out in aprevious blog as lifestyle changes, but each lifestyle is spelled out to a greater degree than most do. In the process of making changes, this blog may assist you in what you need to do. For those medically able to exercise, my blog on safe blood glucose levels for exercise should be of help once you have talked it over with your doctor.

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