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Monitoring blood glucose: New guidelines suggest more may be better

Jan 22, 2013

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?


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  1. May 28, 2015

    Carla, what excel sheet are you using? The one done by Bayer or one of your own? I am always on the lookout for great tools. To answer Christine's question, I know the Relion Prime comes with just the meter and I have not seen the control solution on the shelves at Walmart. I suspect there is one, but would guess you have to call the manufacturer. Because the solution goes out of date once opened and must be replaced, I am not sure many want to get it. Are there recommendations for how often to use it? I know when we did the codes for new bottle of strips, they sometimes recommended testing the machine to be sure. I am curious as to what others are doing here.
  2. Feb 17, 2013

    I work in home care. The majority of my patients do not test the accuracy of their meters using control solution usually because they never heard of it nor have it available. Cost and instruction on use aside...Do all meter manufacturers require this control test? Are there meters that do not require this step? To meet agency and JCAHO standards we are being asked to document whether the meter has been tested and IF we are reporting results from a home meter to a physician, he/she must be informed if quality control has been performed. Can we make things even more complicated for the patient?
  3. Feb 06, 2013

    I agree with Carla about the importance of monitoring but have encountered a huge problem with my Medicare patients. Medicare specifies that patients on insulin are only allowed to test 3x per day. I don't have a problem with this if a patient is only taking a basal insulin. However, it becomes very problematic and unsafe if a patient is on MDI or CSII. I really feel that as educators, we need to get together and lobby for Medicare to change these guidelines. They need to revise the guidelines to include insulin: basal only (with 3 tests per day) or MDI (allowing for 4x per day). IF they revised their guidelines, then my patients using MDI and on Medicare (and I have a lot of them since I work in a retirement community) would be able to test their blood glucose before every meal AND at bedtime. Not knowing what blood sugar is prior to going to bed is asking a patient to be unsafe. Many pharmacies now, are refusing to fill over 3x per day because of Medicare audits. Even if the prescription is written for 4x per day, they sometimes won't over ride it. I was wondering if anyone else is struggling with this Medicare policy. If you are, then we need to get together as a group of educators and try to get the policy changed
  4. Feb 05, 2013

    Oh I am so glad read your articile. So refreshing to know that how many of use agree to checking BG levels multiple times. All the years of fighting physicians, insurance carriers etc. with the understanding of how BG monitoring can aide in better lifestyle choices, improve BG control which will decrease risk of complications etc etc etc. Unfortunately it appears that we are on the verge of allowing those with diabetes less of an opportunity to acquire BG strips. What now? Who makes these decisions? The people I see type 2, type 1 insurance no insurance, the majority when given information to make decisions and know how to interpret BG levels want that opportunity. They want the flexibility of checking when the need arises. How unfortunate.
  5. Jan 29, 2013

    I teach exactly what you're saying, but how do you get the physicians on board when they are telling their patients that fasting BG is the only one that is needed? This confusing to the patient and frustrating for me when I am also trying to control their postprandial and other mealtime blood sugars.
  6. Jan 22, 2013

    These updated guidelines are so overdue, and it's great to see the ADA finally taking a realistic look at the number of blood checks we should be doing every day. We wrote a post recently on these guidelines over at DiabetesMine, and many in the D-Community echoed that sentiment of being glad to see this from the ADA. Thanks for sharing this with the AADE membership and others who read this great blog!

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