Self-monitoring of blood glucose (SMBG)is important for people with all types of diabetes; however, I wantto cover this for type 2. Just recording the results of your bloodglucose readings in a log or journal gives you much information aboutyour health. This recording of your blood glucose levels gives youvisual evidence of your diabetes and how you are managing it. Italso means that you are looking for ways to manage diabetes moreeffectively.
SMBG is an important task manager and aconstant reminder on a daily basis of your goal for effectivediabetes management. SMBG does require knowledge of what you aredoing and the reasons for doing this important task. Some physicianswill assist in encouraging you to test regularly and others couldcare less as all they want to see is the HbA1c (A1c) results as thisgives them a three-month look back at how you are managing yourdiabetes.
We as patients also need the A1cresults as this will give us information needed for adjusting ourtesting routines and it will tell us if we are doing it correctly. Agood calculator for converting the A1c to average blood glucosereadings is found here. If you use this and compare your average readings, you will be able to see how well, or not, you are managingyour blood glucose. This will let you know if you are managing toprevent the spikes in your blood glucose. If not then you know thatyou have work to do to adjust when you are testing your blood glucoseand that you need to work on managing what you are eating.
The purpose or goal of SMBG is tocollect information about blood glucose levels at different timesduring the day to assist you in creating a more level blood glucose. You will use this information to adjust your regimen in response tothe blood glucose values. This will mean adjusting your food intake,physical activity, and possibly medications with your doctor’sdirection.
SMBG can aid in diabetes control by:
- facilitating thedevelopment of an individualized blood glucose profile, which canthen assist health care professionals in treatment planning for anindividualized diabetic regimen;
- giving people withdiabetes, and their families, the ability to make appropriateday-to-day treatment choices in diet and physical activity as well asin insulin, oral agents, and even no medication;
- improving patients’recognition of hypoglycemia or severe hyperglycemia; and
- enhancing patienteducation and patient empowerment regarding the effects of lifestyleand pharmaceutical intervention on glycemic control.
Patients properly educated and withsome experience with SMBG can benefit from the empowerment that SMBGbestows. Diabetes specialists believe that patients should use theSMBG data for daily regimen changes and health care professionalsshould use SMBG data to guide changes in medication regimens.
The use and frequency of SMBG is thearea of much disagreement among the various specialists and advocatesof SMBG. From my prospective, I feel it will depend on what yourbudget allows and insurance will cover. With all that is happeningwith studies it is surprising we still have testing supplies. Somedoctors will not even give prescriptions for testing supplies andothers will delay this until the patient insists. Most insuranceswill cover a meter and test strips up to what Medicare allows for thetype of diabetes you have and the medication you are taking. SMBG isthe battleground for all people that need testing supplies. Medicarerestricts testing supplies and most insurance companies follow inlock step.
If you are able to afford additionaltesting supplies, by all means, make good use of them. Shortly afterdiagnosis, you need to use your meter to determine how differentfoods affect you blood glucose. This will assist you in knowingwhich foods to decrease in quantity, which to eliminate from the menufor now and which are safe to continue eating. Most people that areconscientious about their testing and realize that readings aretrending upward will want to retest their foods again and find outwhat is changing.
We all need to understand the reasonsfor doing certain tasks and the more we understand aboutself-monitoring of blood glucose, the more effectively we will useit. I am not in agreement with the current trend in testing forpeople with type 2 diabetes. The powers that be just do not allowfor proper testing or frequency of testing needed to cover periodswhen your body chemistry may change, for determining what foods dofor your blood glucose levels, whether an illness is affecting yourblood glucose, or if a medication, especially steroids, is drivingyour blood glucose above normal levels. These are concerns allinsurance companies do not even allow for. Even our medicalcommunity shows little interest in this and will deem you to be notwatching your blood glucose when your A1c rises unreasonably.
For patients with type 2 diabetes,optimal SMBG frequency varies depending on the pharmaceutical regimenand whether patients are in an adjustment phase or at their targetfor glycemic control. If a patient is on a stable oral regimen withA1c concentration within the target range, specialists recommendinfrequent SMBG monitoring. In such cases, patients can use SMBG dataas biofeedback at times of increased stress or changes in diet orphysical activity.
Finally, the following steps shouldbe part of your guidelines for testing blood sugar levels; you shouldget specific details for your blood glucose monitors from the packageinsert or your healthcare provider. Never share blood glucosemonitoring equipment or fingerstick lancing devices. Sharing of thisequipment could result in transmission of infection, such ashepatitis B.
- Wash hands carefully withsoap and warm water paying attention to the finger you will use, andthoroughly dry your hands.
- Prepare the lancing deviceby inserting a fresh lancet. Lancets that are used more than once arenot as sharp as a new lancet, and can cause more pain and injury tothe skin. This is the recommendation from the manufacturers, but Ichange mine only once a month or when testing on my wife's finger.
- Prepare the blood glucosemeter and test strip (instructions for this depend upon the type ofglucose meter used).
- Use the lancing device toobtain a small drop of blood from your fingertip or alternate site(like the skin of the forearm). Alternate sites are often lesspainful than the fingertip. However, results from alternate sites arenot as accurate as fingertip samples when the blood glucose is risingor falling rapidly. Actually they can be approximately 20 minutesbehind the levels obtained from your fingertips. This is not goodwhen blood glucose levels are falling rapidly.
- Apply the blood drop tothe test strip in the blood glucose meter. The results will bedisplayed on the meter after several seconds.
- Dispose of the used lancetin a puncture-resistant sharps container (not in household trash). Sharps containers may be obtained from your local pharmacy andoccasionally you may need to wait a few days to allow them to receivea new order.
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