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Self Monitoring Blood Glucose Chart

SMBG – What Should a Person Know?

Diabetes is a global problem, and poor management of condition along with delayed diagnoses are emerging as significant issues. People with diabetes know that it cannot be cured and needs lifelong treatment. However, many people do not recognize that prediabetes and early diabetes can be reversed in many cases, or at least progression delayed. Thus self-monitoring of blood glucose (SMBG) has importance for both diagnosed with diabetes (for better management) and those at risk.

In developing nations like India, things are even worse as the diagnosis is often delayed due to neglection. Although self-blood pressure monitoring is quite frequent in developing countries, SMBG remains a neglected thing.

Considering the epidemics of diabetes in India and world at large, every home must have a glucometer, and SMBG must be a part of disease management from the very beginning. However, in resource-poor nations, it is vital that frequency of SMBG must be individualized.

Below are some of the recommendations regarding SMBG by the International Diabetes Federation (IDF):

  • SMBG should be an essential part of diabetes treatment program, and every individual with diabetes must have adequate knowledge about it and must be willing to adjust the lifestyle according to the health goals.
  • For proper monitoring of diabetes, SMBG should be done regularly from the day of diagnosis.
  • SMBG should be an ongoing process for better adjustment of dosages of medications, for understanding the disease, in consultation with the specialist.
  • The frequency of SMBG can be decided according to the severity of disease, type of diabetes, and financial status of the person.
  • A person must document the results of SMBG.

Benefits of regular glucose monitoring

In developing nations, physicians would often make decisions based on fasting glucose test done before the visit to physician’s office, or in some cases medical specialist would ask for HBA1C. However, these methods lack the information regarding the daily fluctuations in blood glucose levels, thus making clinical decisions for doctors more difficult, and resulting in the lower effectiveness of therapy.

Well documented results of SMBG can provide the valuable information to the clinician. Various random clinical trials have demonstrated the benefits of SMBG in lowering the HBA1C. Some of the benefits of SMBG are:

  • It is beneficial in optimizing the medications regimen or selecting the drugs.
  • If done at an adequate frequency, it provides useful data to predict the course of the disease and thus helping to prevent complications.
  • It helps to recognize both the hyperglycemia (high blood glucose level) and hypoglycemia (low blood glucose levels), and thus improving the quality of life and decreasing the risk of complications.
  • It also raises awareness about the disease and keeps a person motivated, thus improving adherence to lifestyle changes and medications.

While, there is no consensus on how frequently should one check blood glucose levels, especially such recommendations are more difficult to make in resource-scarce nations, however, more frequent is better. Benefits of SMBG in type 1 diabetes are more widely accepted than in type 2 diabetes.

SMBG and type 1 diabetes

5-10% of those living with diabetes belong to type 1 diabetes; these are the people diagnosed with diabetes at a young age, in the majority of cases before the age of 30. Insulin is the only proven treatment method for type 1 diabetes. Frequent SMBG is strongly recommended for type 1 diabetes as people living with it are at the risk of both hyperglycemia and hypoglycemia. Hypoglycemia more commonly occurs due to wrong or untimely dosage of insulin and may lead to fatal complications.

In severe cases, or in poorly controlled instances, a medical specialist would usually target the control of so-called pre-prandial (before food) blood glucose levels. Once the pre-prandial control has been achieved, physicians and patients must focus on the optimal control of post-prandial levels.

Although the frequency can be individualized and there are no hard and fast rules, below are two examples of how often to carry out the pre-prandial or post-prandial monitoring.

Table 1 Example of SMBG in Type 1 diabetes- targeting pre-prandial blood glucose levels

DaysFastingAfter breakfastBefore LunchAfter LunchBefore DinnerAfter Dinner3 AM
Mon
Tue
Wed
Thu
Fri
Sat
Sun

 

Table 2 Example of SMBG in Type 1 diabetes- targeting post-prandial blood glucose levels

DaysFastingAfter breakfastBefore LunchAfter LunchBefore DinnerAfter Dinner3 AM
Mon
Tue
Wed
Thu
Fri
Sat
Sun

 

SMBG and type 2 diabetes

More than 90% of those living with diabetes have type 2 diabetes, and an only small fraction of them are on insulin. For those on insulin frequency of SMBG should be similar to type 1 diabetes. However, in type 2 diabetes a large number of people are on oral drugs and fluctuations of blood glucose are not that severe. Thus the use of SMBG in type 2 diabetes has to be much less intensive. Below are two examples of SMBG in type 2 diabetes. One can select the frequency according to the severity of the disease and financial capabilities.

Table 3 Example of SMBG regimen for poorly controlled diabetes

DaysFastingAfter breakfastBefore LunchAfter LunchBefore DinnerAfter Dinner3 AM
Mon
Tue
Wed
Thu
Fri
Sat
Sun

 

Table 4 Example of SMBG regimen for well-controlled diabetes

DaysFastingAfter breakfastBefore LunchAfter LunchBefore DinnerAfter Dinner3 AM
Mon
Tue
Wed
Thu
Fri
Sat
Sun

 

In conclusion, it would be correct to say that SMBG has to be an essential part of diabetes treatment, though there is need of individualizing the frequency by keeping in mind the severity of disease and financial capabilities of the individuals.

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