Diabetes: Glucose Monitoring and Insulin Treatment

The most important information you need to improve your health

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• Publisher: Adams Media
• Year: 2012
• ISBN:
  9781440540790
• Topic: Medicine
• Subtopic: Diseases & Allergies

If you or a family member has been diagnosed with diabetes, you may feel overwhelmed by the challenges associated with this disease. The Everything® Healthy Living Series is here to help. These concise, thoughtful guides offer the expert advice and the latest medical information you need to improve your health. Aside from having a lab in your medicine cabinet, this is your best tool for managing diabetes, monitoring your glucose level, and understanding the importance of insulin. You'll find tips and advice on testing your blood sugar, tracking results, and administering insulin.
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Self-Monitoring of Blood Glucose

A home blood glucose monitor — a device that analyzes a blood sample and gives you a reading of your current blood sugar levels — is the next best thing to having a lab in your medicine cabinet. Monitors (also called meters) are probably the single, most useful tool you have for knowing what’s going on with your diabetes, mainly because they are always accessible, provide instant results, and don’t require a trip to the doctor’s office.

Why Test?

Regular self-monitoring of blood glucose levels (SMBG) gives you a quick clinical snapshot of exactly where your blood glucose levels are at any given moment. Testing, and keeping a detailed log of test results and the circumstances that surround them, will help you understand how certain foods and activities affect your blood sugar. Once you are able to detect patterns in blood glucose changes over time, you can use the information to adjust your treatment accordingly.

The Diabetes Control and Complications Trial (DCCT), a landmark clinical study, found that tight control of blood glucose levels using SMBG significantly reduced the risk of diabetes-related complications. Since the study was published in 1993, the ADA has developed guidelines on SMBG and home testing has become a recommended, routine self-care practice.

Another role of SMBG is to help you assess how effective your medication or insulin is in controlling your glucose levels. It is also an invaluable tool for adjusting the timing of medication to ensure the best possible control.

Question

I can’t stand the thought of sticking myself. Can’t I just test for sugar in my urine?

You could, but it would do little to help you control your diabetes. Because urine collects in your bladder for several hours before it leaves the body and only contains glucose when blood levels are over 180 mg/dl, it isn’t a very timely or sensitive test. Worse, it cannot help detect potentially dangerous low blood sugar levels.

Perhaps most importantly, SMBG can help you avoid life-threatening blood sugar emergencies. If you are under stress, sick with the flu, or taking medications that affect blood glucose levels, regular testing can help you keep close tabs on your blood sugar levels so you can take action before they go dangerously high.

Alert

Home glucose testing is particularly important for people with hypoglycemic unawareness. These individuals have lost the ability to perceive the normal warning signs that blood sugars are dropping too low — such as shakiness, anxiety, dizziness, irritability, and rapid heartbeat.

Testing before, after, and possibly during exercise can help you avoid a precipitous drop in blood glucose levels. It’s also wise to test if you’ve been drinking alcohol, another trigger for hypoglycemia. If you feel a low coming on, a quick test can confirm your levels so you can take action immediately.

Developing a Testing Schedule

When to test is a matter of debate. Some people test once when they wake up. Others test eight or more times a day — morning, night, and before and after meals. As a general rule, when your diagnosis is new and you’re learning how different factors affect your diabetes, checking your glucose levels frequently is encouraged. The same holds true for monitoring any changes to your treatment routine.

People on insulin therapy may need to test more frequently, since they need to use the results to adjust insulin accordingly. And people with glucose levels that fluctuate widely, often without warning (a condition formerly known as brittle diabetes), may also need to test more frequently than others.

Alert

If you suspect a blood sugar low, you should always test yourself immediately. Treat yourself with 15 grams of fast-acting carbohydrate, wait fifteen minutes, and then test again. If blood sugars are still not in a safe range, repeat the process. If your meter isn’t around but you feel low, treat it first and test later.

When to Test

The ADA recommends that people who are on multiple insulin injection therapy or insulin pumps test at least two or three times daily. However, it is not unusual for people on these therapies to test much more frequently, as an accurate blood glucose number is essential to determining insulin dose and keeping blood sugars in a safe range.

There are no specific ADA recommendations for frequency of testing in type 2 diabetes patients who aren’t on insulin, or for diabetes patients who are on once or twice daily insulin injections. But again, self-monitoring of blood glucose levels is the best available tool to provide immediate feedback on how food, exercise, medication, and other environmental factors are affecting blood sugars. Although the cost of testing supplies can sometimes be a barrier, self-monitoring should be performed as frequently as possible to help achieve blood sugar goals.

Postprandial, or after-meal, testing is also encouraged at one and two hours after eating. Testing after meals allows you to see how different foods and food combinations impact your blood sugar levels, and also is a helpful tool in revealing trends that can help to bring down a high A1C.

Fact

In the United States, home blood glucose monitors display readings as mg/dl (milligrams over deciliters). However, everywhere else outside the United States, the standard is mmol/l (millimoles over liters). Some monitors that are sold internationally may have an option for switching back and forth between mg/dl and mmol/l displays.

Overcoming Testing Barriers

It’s natural to have some hesitation about sticking yourself on a regular basis. But it’s important to realize that today’s lancets, the needle-like devices used to prick your finger to obtain a blood sample, are extremely fine, easy to use, and virtually painless. Your diabetes educator can show you simple methods for drawing an adequate blood sample with minimal discomfort.

Cost can have an impact on how frequently you can test. When determining a schedule for blood glucose testing with your doctor, make sure you discuss any financial or insurance issues that may affect your testing routine. Test strips are expensive (a package may cost more than the monitor itself), and some insurance plans put a cap on the quantity of testing supplies they will cover for a...

Table of contents

• Cover
• Title Page
• Contents
• Introduction
• Self-Monitoring of Blood Glucose
• All about Insulin
• Also Available
• Copyright Page