Perspectives on Diabetes Care

Monitoring blood glucose: New guidelines suggest more may be better

Jan 22, 2013, 00:00 AM

The importance of monitoring blood glucose (BG) and responding to the results is well-established as a critical part of managing type 1 diabetes.  The 2013 ADA Clinical Practice Recommendations (Diabetes Care, 2013) suggest checking AT LEAST prior to meals and snacks, occasionally post-prandially, after treating low blood sugars until normalized and prior to critical tasks such as driving.  This is much more directed guidance than previous recommendations of “three or more times daily” (Diabetes Care, 2012).

Benefits of monitoring have not been consistently demonstrated when patients with type 2 diabetes are on lifestyle-controlled regimens or oral medications (The Diabetes Educator, 2007; Health Technology Assess, 2009). Data aside, I believe all of us have seen how much patients learn about their BG response to meals, exercise and environmental pressure when checking BG values throughout the day, regardless of whether it’s controlled via lifestyle or medication.  This is with the caveat, of course, that they understand how to interpret the results.  This belief is reinforced with the 2013 recommendations, “When prescribed as part of a broader educational context, SMBG results may be helpful to guide treatment decisions and/or patient self-management for patients using less frequent insulin injections or noninsulin therapies.” (Diabetes Care, 2013 - Expert Opinion)

The too often practiced once per day testing of BG values can only go so far to provide information.  Wrapping meals with BG monitoring (pre and two hour post-prandial) can help an individual see the influence food choices have on BG response.  If interpreted correctly, this has the potential to encourage wiser choices that may result in overall better BG control and therefore a reduction in A1C.  Hopefully providers are beginning to understand the importance of monitoring throughout the day, and are referring patients to diabetes educators for guidance on how to interpret the results and make lifestyle or medication adjustments for optimal diabetes control.

Choosing the correct monitor and lancet device for the patient is also a key to BG monitoring success. Due to the high cost of strips, I often refer underinsured individuals to less expensive brands of monitors, which may not have all the bells and whistles that we all enjoy, but with using a simple handwritten log or excel spreadsheet, can provide much of the same information for a fraction of the cost.
 
Blood glucose monitoring is a cornerstone of diabetes education.  Blood sugars shift throughout the day and often get progressively higher over time even in the “best” patient with type 2 diabetes.  As diabetes educators, we are the “go to” persons to help guide patients to understand their BG results and to learn to act on the results to help normalize blood sugars and reduce risks associated with frequent BG values that are out of range.   How are you helping patients utilize their results for optimal diabetes management?