With the first baby boomers entering their 60’s in the next couple of years, the possibility of an overwhelmed health care system is not unheard of. Combine with that the fact that approximately 20.8 million people in the United States (7% of the U.S. population) are afflicted with diabetes and an additional 54 million are thought to have pre-diabetes¹. Needless to say, it is more important than ever that today’s diabetic population empower themselves and take control of their diabetes.  

If you are a diabetic, one of the first steps in taking control of your diabetes is to begin monitoring your blood glucose at home. Learning to self-monitor your blood glucose is easy to learn and provides essential information to you and your doctor regarding the effectiveness of your current diabetes therapy.  

Given that self-monitoring of blood glucose (SMBG) has become a standard of practice in recent years, its hard to believe that many patients diagnosed with diabetes will not be given a prescription for a glucose monitor by their doctor.  This is especially hard to believe given that recent studies show that tight control of blood glucose is essential to preventing complications that can lead to damage to the eyes, kidneys, heart and other organs ^2,3.  

SMBG provides you and your doctor with important information on your blood glucose levels at certain points in the day. By analyzing your blood glucose patterns, adjustments can be made to your medication and eating habits as needed.  

Insulin-dependent Diabetes

For insulin-dependent patients, SMBG provides feedback on fasting blood glucose (FBG) and postprandial glucose ( PPG or post meal glucose).  FBG and PPG readings can be used to adjust basal insulin (e.g.-Lantus® or NPH insulins) and shorter-acting insulin (e.g.-regular or lipsro insulins). SMBG is also extremely important if you are prone to hypoglycemia (low blood sugar). Checking your blood glucose when you start to experience symptoms of hypoglycemia can help you make much needed adjustments to your food and insulin/medication intake. In a way, SMBG takes the place of your body’s own ‘sugar thermostat’ that may not be working like it used to.  

The American Diabetes Association (ADA) and American Academy of Clinical Endocrinologiests/American College of Endocrinology ( AACE /ACE) have published recommendations regarding how often SMBG should be done and what goals to look for in those readings^4,5. Both the ADA and AACE /ACE agree that all patients on insulin therapy, whether they have Type 1, Type 2 diabetes or gestational diabetes, should practice SMBG. 

Non-insulin-dependent Diabetes

How often non-insulin-dependent patients should monitor their blood glucose is less clear. Both organizations agree that SMBG is useful in these patients, but do not specify specific intervals for testing. Instead, both the ADA and AACE /ACE recommend that non-insulin patients check their blood glucose as needed to meet their therapeutic goals.  

Finally, both organizations recommend testing more frequently in times of stress, illness or when diet or exercise habits change, whether you are insulin-dependent or not.

What should MY Blood Sugar Goals Be?

The following is a summary of the SMBG recommendations put forth by these two organizations.  

Table 1   Blood Glucose Reading Targets from the ADA and AACE /ACE^4,5

Table 2   Recommendations for Frequency of SMBG Testing^4,5

When Should I Test?

Although these organizations provide recommendations as to how often to test blood glucose , they are not specific as to when these tests should take place during the day. After first being diagnosed, patients may need to test more often, for example before and after each meal and at bedtime.  These readings will help assess how their insulin and/or medications are working and allow them to make adjustments if needed.  After dosing of insulin and/or medications are stabilized, frequency of SMBG can occur less frequently.   

It is important to realize that the above recommendations were developed based on sound clinical evidence, however, they are still just suggestions.  Diabetic patients should work closely with their doctor to determine a SMBG testing schedule and targets that are right for them. 

Author: Christi Larson, Pharm. D.

REFERENCES

1. American Diabetes Association. Diabetes statistics. Total prevalence of diabetes & pre-diabetes. Available at http://www.diabetes.org/diabetes-statistics/prevalence.jsp.   (Accessed November 28, 2006 ).

    

2. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703-713.

    

3. The Diabetes Control and Complications Trial Research Group. Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol. 1995;75:894-903.

    

4. American Diabetes Association. Summary of revisions for the 2005 clinical practice recommendations. Diabetes Care. 2005;28:S3.

    

5. American Association of Clinical Endocrinologists and American College of Endocrinology. Implementation conference for ACE outpatient diabetes mellitus consensus conference recommendations: position statement. Available at http://www.aace.com/pub.pdfguidelinesOutpatientImplementation PositionStatement.pdf .  (Accessed November 28, 2006 ).