October 8, 2014

Self-Monitoring of Blood Glucose, Lessons - P1

This is a continuation of previous blogs on self-monitoring of blood glucose (SMBG). In rereading several, I realized that they were okay, but not as complete as they should have been. In the blog over at DiabetesMine on September 27, 2014, Will Debois wrote about a few points I have been taught, but forgot about. Two of my fellow support group members, Allen and Tim called me after reading that blog and asked when I was going to write about it. I urge you to read the DiabetesMine blog at the link above.

Yes, I have talked about testing before meals and then after meals, but I have not been the best at explaining some of the reasons. So, here goes! The points I want to cover include are:

#1. Dr. William Polonsky of the Behavioral Diabetes Institute who came up with the concept and coined the accurate term “testing in pairs” to make it easy to understand.  Why you need the preprandial (before meal) and postprandial (after meal) blood glucose tests.

#2. The reason I can avoid the guidelines of the ADA and AACE.

#3. Facilitating the development of an individualized blood glucose profile, which can then assist health care professionals in treatment planning for an individualized diabetic regimen?

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.

This is the reason for testing in pairs. One reading postprandial is worthless and tells you nothing. It does not tell you what the increase may have been from the food consumed, or even if you need to reduce your food consumption. Okay, if the preprandial dinner reading was 105 mg/dl and at 90 minutes postprandial, the reading is 148 mg/dl, then this means that the increase was 43 mg/dl. Now this says something and depending on the goals you have set, you can make adjustments. Do you need to reduce your food consumption (the carbohydrates), do more physical activity, or if on insulin adjust the dosage injected?

If on oral medications then the readings may mean that the physical exercise needs to be increased or the food consumed needs to be reduced. If the person is on no medications, then the person needs to consider medications or less food.

As Will explained, it does depend on whom you work for as to the guidelines followed. The ADA guidelines are the most lax and the AACE guidelines are somewhat better. When it comes to fasting blood glucose levels, I agree with Will that anything below 70 mg/dl causes concern and should be discouraged. I have had readings lower and being on insulin, I was very concerned. I do not work and am retired and as such only answer to myself. I can set my own ranges for my goals and if I don't meet them, then I have only myself to blame. Yes, all doctors try to set goals for me and I generally tell them that the goals are not realistic (an A1c above 7.5% - because of my age) and thus I will use my goals (6.5% and lower).

Yes, I am not cooperating with my doctors and am in the process of finding another so I am not facilitating number 3 above.

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