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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