Blood glucose self-monitoring in management of adults with diabetes mellitus
- David K McCulloch, MD
David K McCulloch, MD
- Washington Permanente Medical Group
All patients with diabetes mellitus who use insulin and some patients who take other glucose-lowering medications that can cause hypoglycemia should measure their blood glucose concentrations to help maintain safe, target-driven glucose control. The effectiveness of self-monitoring in patients with type 2 diabetes who do not use hypoglycemic agents is less certain.
Self-monitoring of blood glucose (SMBG) usually requires intermittent capillary blood sampling and the use of a glucose meter, with different frequencies of testing indicated for type 1 and type 2 diabetes. Devices to sample the glucose continuously from subcutaneous fluid are also available, with ongoing development in progress.
In addition to SMBG, periodic measurement of glycated hemoglobin (A1C) estimates chronic glycemic control. Several practical points about blood glucose monitoring will be reviewed here, including the accuracy of glucose meters and glucose test strips, the accuracy of the operator, and how to use the glucose information that is obtained. The use of A1C measurements to estimate mean blood glucose is reviewed elsewhere. (See "Estimation of blood glucose control in diabetes mellitus".)
Based upon the results of randomized trials (described below), we suggest SMBG in patients who take medications that can cause hypoglycemia and that need to be adjusted based on ambient glucose levels. For example, in order to avoid hypoglycemia and achieve target glucose levels, patients with type 1 diabetes who take mealtime insulins should usually test before meals to adjust doses, based on meal size and content, anticipated activity levels, and glucose levels. Similar guidelines apply to insulin-treated type 2 diabetes, although their glucose levels are characteristically more stable, and they may require less frequent monitoring.
Patients treated with sulfonylureas or meglitinides, which can also cause hypoglycemia, should be tested once to twice per day during titration of their doses but, after a stable dose and target glycemic targets are achieved, may only need to test several times per week, usually in the morning or before dinner. All insulin and sulfonylurea patients need to test more frequently before and during long car rides, during sick days, and when there are changes in diet and exercise patterns.
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- Type 1 diabetes
- Type 2 diabetes
- SOURCES OF ERROR IN SMBG
- Blood glucose meters
- Glucose strips
- Site of testing
- USING THE INFORMATION
- CONTINUOUS GLUCOSE MONITORING
- Patient selection
- PATIENTS WITH SPECIAL NEEDS
- URINE TESTING
- Testing for ketonuria
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS