Guest Post from David Mapletoft, Diabetes Educator
Do you use your blood glucose level meter like a compass, giving you some direction with your diabetes self care plan? And if so, is missing an occasional blood glucose level really a problem?
At a meeting of diabetes health care professional specialists a few years ago I met an endocrinologist specialising in the diabetes management of young people living with diabetes. This specialist stated that she didn’t really mind if her patients measured their blood glucose level between visits…… except for the 2 weeks immediately prior to the visit. For these measurements were the current ones – that bgls that she would base any treatment changes on.
Among other things, a measured pattern of your blood glucose levels will help you to:
- Develop confidence in your diabetes self care plan
- Develop a improved understand of the relationship between your blood glucose levels the factors that affect them: e.g. physical activity, food you eat, stress and illness.
- Explore if your diabetes medication, if used, is safe and effective in helping you reach your blood glucose level targets.
- Assess in critical situations if your blood glucose levels are in the extremes and require immediate management
For anyone with diabetes, personalised education by qualified and experienced healthcare professionals in appropriate blood glucose targets and timing of your checks, interpretation of the results and trends across and between days, is essential.
Suggested patterns of checking could be :
1) You could check before and 2 hours after meals on 3-4 consecutive days to establish your current pattern. If you identify that your blood glucose levels are off your target, more checking may be needed to give you enough information to make appropriate adjustments to your diabetes self care plan.
2) For people with type 2 diabetes – You could check once per day, moving the check time each day forwards by one appropriate time e.g Monday before breakfast, Tuesday after breakfast, Wednesday after lunch, Thursday after dinner, Friday before breakfast and so on. After a few weeks you can then assess the pattern to see what is happening, with the support of your doctor or diabetes educator.
3) Checks before and after a new meal: this will give you some idea of how your body is adjusting to this new meal, or different foods. You may have changed the type of food you eat, or the volume of the carbohydrate in your meal based on advice from your dietitian.
4) Checks before, after, during exercise: assessing your risk of hypoglycaemia and your body’s reaction to the exercise.
If you have type 2 diabetes and are not on insulin or medication, once you establish if your blood glucose levels are generally where you would like them to be, you might decide to check less frequently, and/or only when you are thinking you may be hypoglycaemia or sick.
*For people with type 1 diabetes, avoiding DKA is essential when sick – in this situation follow your sick day plan.*
It is very important to remember that blood glucose targets need to be individualised for each person with diabetes.
Clinical trials targeting intensive blood glucose control such as the DCCT typically exclude people at highest risk of severe hypoglycaemia, with advanced end‐stage diabetes complications, with poor adherence to therapy or with major intercurrent medical conditions (DCCT Research Group 1993).
The average duration of diabetes was only 2.6 years at study entry in the intensive treatment arm of the DCCT, for the average 6.5 years’ study duration. Thus, the DCCT and EDIC mainly examined the importance of tight glycaemic control in the first 10 years after diabetes diagnosis. In contrast, glycaemic control typically becomes more difficult to achieve safely with increasing diabetes duration of, and both a lack of hypoglycaemia awareness and severe hypoglycaemia become increasingly common.
Blood glucose self-monitoring is usually recommended for people with type 2 diabetes:
- when on insulin and oral hypoglycaemic agents (OHAs) that can cause hypoglycaemia
- when monitoring hyperglycaemia arising from illness
- with pregnancy, as well as pre-pregnancy planning
- when changes in treatment, lifestyle or other conditions requires data on glycaemic patterns
- when HbA1c estimations are unreliable (e.g. haemoglobinopathies).
The method and frequency of monitoring need to reflect individual circumstances and therapeutic aims and where the person with diabetes and their healthcare providers have the knowledge, skills and willingness to incorporate self monitoring of blood glucose levels and therapy adjustments into diabetes care plans.
What are your personal diabetes goals?
Sometimes people have very loose ideas about their goals, which makes it harder to take action. For example, “I want normal blood glucose levels”. Something more specific may be “I want to avoid hypoglycaemia” or “I don’t want any blood glucose levels over 15 mmols”. You may want to consider how to write effective goals that are specific and time limited.
“In the next 3 months, (between now and my next HbA1c test) I shall measure my blood glucose level every week for 3 days when I wake up, and also before and after each meal. If my bgls are over or under my personal target I shall check daily for a week and show the results to my GP”
Missing an occasional blood glucose check is not going to change this goal. The more information you can provide to yourself the more likely it is that your diabetes self care plan will be safe and effective.