How to Self-Monitor Blood
Glucose Level

chillibreeze writer — Sowmya Gopalakrishnan

Diabetes—Implications and Prevalence

Diabetes Mellitus is an endocrine disorder, characterized by defective insulin production/secretion resulting in compromised glucose metabolism. This condition is classified into Type I and Type 2; based on either complete or partial loss of endogenous pancreatic insulin production.

Several factors like genetic predisposition, inadequate diet and exercise patterns, increasing weight and truncal obesity could also contribute. 1 Clinically, Diabetes serves as a precursor to long-term end organ damage. Problems related to dysfunction of eyes (retinopathy), kidneys (nephropathy), nerves (neuropathy) and certain autonomic dysfunctions are often encountered. People with diabetes are also predisposed to cardiovascular, cerebrovascular and peripheral artery disease.1

India has gained the title “diabetes capital of the world” after the estimated 40.9 million people with diabetes in India. The figure is expected to rise to 69.9 million by 2025, as published in the Diabetes Atlas 2006 by the International Diabetes Federation.2

Value of Self-Monitoring in Diabetes

It is very challenging for a person with diabetes to constantly be conscious of when, what and how much to eat as well as be aware of the exercise needed to balance with external insulin/medication. Self-management/self-care gives the freedom to choose a lifestyle not dictated by diabetes. People who self-manage feel that they are more in control of their lives and often report a better quality of life with better outcomes and fewer complications with the advantage of lesser costs.3

The great clinical value of regular Self-Monitoring of Blood Glucose (SMBG) has been proven beyond doubt in terms of measurable improvement in overall glycemic/A1c control.

The specific benefits are listed below:

• Detects blood glucose fluctuations, facilitating adaptations to reach long-term A1c goals
• Offers protection by hands-on confirmation of acute hypoglycemia or hyperglycemia
• Creates higher awareness of the disease and its management by giving patients more self-care responsibilities
• Overall motivation towards healthier behavior and better quality of life.4

Sufficient clinical evidence from meta-analyses has been reported by Sarol et a, Welschen et al and Saudek in 2006 showing improved A1c values in T2DM patients who self-monitored. 5–7

ADA Guidelines-2008-Position statement SMBG should be carried out three or more times daily for patients using multiple insulin injections or insulin pump therapy. (A) For patients using less frequent insulin injections, noninsulin therapies, or medical nutrition therapy (MNT) alone, SMBG may be useful in achieving glycemic goals. (E) To achieve postprandial glucose targets, postprandial SMBG may be appropriate. (E) When prescribing SMBG, ensure that patients receive initial instruction in, and routine follow-up evaluation of, SMBG technique and their ability to use data to adjust therapy. (E) Continuous glucose monitoring may be a supplemental tool to SMBG for selected patients with type 1 diabetes, especially those with hypoglycemia

Populations where Self-Monitoring is critical

Although self-monitoring is beneficial to any person with Diabetes, SMBG forms an integral part of treatment plan in certain special populations who require continuous monitoring of blood glucose levels. This comprises of patients with Type I DM, those with insulin intense therapy, pregnant women, critically ill diabetics, people recuperating after surgery, diabetics with a lifestyle of high physical activity, recurrent hypoglycemia and those who are not aware of when hypoglycemia occurs. Also, SMBG is useful in diagnosis and epidemiology.8

Timing and Frequency of SMBG

Timing becomes very significant as measurement is episodic, that is, glucose level at a given point of time. Frequency is defined by necessary data that would help patients manage themselves. If any intermittent rise or out-of-range readings in blood glucose are recorded, then frequency of SMBG should be increased. Illnesses and activities variant from routine also require increased frequency of monitoring. For example, consistently high readings in a patient who tests twice-a-week would indicate that probably twice-a-day readings should be taken till the reason for glycemic excursion is diagnosed. Therefore, recommended frequency of SMBG testing will depend on:

• Type of therapy
• Degree of glycemic control
• Risk of hypoglycemia
• Need for short-term adjustment of treatment
• Special situations (pregnancy, intercurrent illness, hypoglycemia unawareness, etc.) 8

Using SMBG in Diabetes Management Plan

SMBG helps achieve good glycemic control through a comprehensive diabetes management plan. Addressing obstacles to blood glucose monitoring could play a cardinal role in attaining optimum glucose levels. Patients can be encouraged to participate actively in their own care by demonstrating the positive effects of being able to tune their treatment or diet regimes to the measured blood glucose levels. Thus, it is very important to include diabetes self-management education as an integral part of the action plan. This ensures that patients learn accurate, reliable monitoring skills and interpretation of results to alter nutrition/exercise/medications to reach specific glycemic goals8. With increasing cases of the disease, diabetes self-management is indispensable in future.

References for the Article:

1. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). ESC and EASD Guidelines. European Heart Journal; 2007.

2. Mohan V, Sandeep S, Deepa R et al. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res. 2007;125:217–230.

3. Wysocki T, Harris M, Wilkinson K, et al. (2003). Self-management competence as a predictor of outcomes of intensive therapy or usual care in youth with type 1 diabetes. Diabetes Care. 26, 2043–2047.

4. Klonoff DC. Benefits and Limitations of Self-Monitoring of Blood Glucose. J Diabetes Sci Technol. 2007;1(1):130–132.

5. Sarol JN, Nicodemus NA, Tan KM, Grava MB. Self-monitoring of blood glucose as part of a multi-component therapy among noninsulin requiring type 2 diabetes patients: a meta-analysis (1966–2004): Curr Med Res Opin. 2005;21:173–183.

6. Welschen LM, Bloemendal E, Nijpels G, Dekker JM, Heine RJ, Stalman WAB, Bouter LM. Self-monitoring of blood glucose in patients with type 2 diabetes who are not using insulin: a systematic review. Diabetes Care. 2005;28:1510–1517.

7. Saudek CD, Derr RL, Kalyani RR. Assessing glycemia in diabetes using self-monitoring blood glucose and hemoglobin A1c. JAMA. 2006;295:1688–1697.

8. Bergenstal RM, Gavin JR, et al. The role of self-monitoring of blood glucose in the care of people with diabetes: report of a global consensus conference. Am J Med. 2005;118(9A):1S–6S.

9. Position Statement: Standards of Medical Care in Diabetes—2008: ADA guidelines— Diabetes Care.2008;31(S1): S17.

 

 

Editor's note: Most articles submitted to Chillibreeze go through a selection process. Only 30 percent of submitted articles are accepted for publication on the Chillibreeze.com featured article list. All accepted articles are edited and proofread for glaring errors of punctuation and grammar. Sentence structure is changed in certain cases and sometimes, entire sections are rewritten. If you notice any errors that have slipped through the cracks, do let us know! (Email us at info at chillibreeze dot com).

Chillibreeze's disclaimer: This is a contributed article and was published on Chillibreeze in August, 2010. The views and opinions expressed in this article are those of the author(s) and do not reflect the views of Chillibreeze as a company. Chillibreeze has a strict anti-plagiarism policy. Please contact us to report any copyright issues related to this article. The relevance of the facts and figures cited (if any) could change after a period of time.

 

More on Chillibreeze.com

Related links

How to Live a Healthy and Active Life With Diabetes
Living with Insulin Resistance and Diabetes
C(h)ords of Life
Umbilical Cord Blood Banking: Why? What? How?
Umbilical Cord Blood Banking

 

 

Other popular articles on Chillibreeze

Go on an Incredible Adventure with Robin ‘Einstein’ Varghese
The Proven Miracle Cure for Weight Loss
How to Set Up the Best Home Office
An Overview of Leicester City, UK
Editor Versus Writer

Out of 5 “chilies”, our editorial team gave this article...

---

—About our writer: Sowmya, a post graduate in Microbiology, is a medical writer with about 4 years work experience in different pharmaceutical companies. She started her career in Nicholas-Piramal (NPIL) on the marketing front and moved to Biocon-Clinigene’s Clinical Research operations, actively monitoring drug trials in oncology, endocrinology, cardiology and nephrology across several centres in India. Later, she worked with BioQuest as a medical writer, developing scientific booklets, review articles, training modules for pharmacology and clinical research.

 

 

 

>> Read more articles written by Chillibreeze writers:

1. Articles related to Content and Outsourcing
2. NRI and Expat Articles
3. Potpourri
4. Travel Writing
5. Book Reviews and Interviews

More resources for Writers on Chillibreeze.com Chillibreeze offers Indian writers the opportunity to work on customer projects. We are also India’s biggest writer network and a one-stop shop for Indian writers and editors. The writers’ section on Chillibreeze offers freelance writers and editors a variety of tools to advance their careers. Resources for writers include: Assessment of your writing, editing and proofreading skills Writing courses Expert Feedback on your article An opportunity to promote yourself on our website Top websites for Indian writers Tips and resources for Indian freelancers Book Publishing services And more……………….. Explore our writers’ section using the links on our left-hand side menu.