If you are feeling overwhelmed or frustrated about managing diabetes, you are not alone. Diabetes affects millions of individuals around the globe with no regard to any specific gender or age group. Studies have shown that early management of blood glucose levels can reduce the risk of developing serious complications associated with diabetes. Self-monitoring is an integral part of diabetes care and helps you control the condition, literally putting you in charge. It helps you set and achieve a glucose level goal and inform your health care provider (your doctor and dietitian) on when to adjust your medical and diet therapy, resulting in better management and improved quality of life.

Two Main Methods of Glucose Monitoring

 Glycated hemoglobin test (HbA1c)

This blood test measures your average blood glucose level of the past two to three months and shows how well your blood sugar is controlled over the period of time. The goal is usually to keep HbA1c ideally below 7% or mean plasma glucose of 150 to 160 mg/dL in people with Type 2 diabetes.

Blood Glucose Monitoring

This is usually done using a blood glucose meter. It gives a direct measure of the blood sugar level at the time of the test and can detect a sharp drop (hypoglycemia ) or rise (hyperglycemia) in blood sugar. This is the method used for self-monitoring especially in Type 2 Patients on insulin. Testing in pairs (before and 2hours after meal) can help you know how you respond to certain foods and inform your dietitian on how to adjust your carbohydrate intake. Glucose goals in adults with either type1 or type 2 diabetes include the following:

• fasting and premeal blood glucose of 70 to 130 mg/dL;
• one- to two-hour postprandial glucose of less than 180 mg/dL

How Often should you do Self-monitoring?

People with Type 1 diabetes need to test frequently at least 4 times per day to effectively manage blood glucose levels. Recommendations for those with type 2 diabetes depend on the type of medication (oral or insulin) and the risk of hypoglycemia and treatment goals. Your health care provider will most likely inform you on how often to check your blood glucose level.

Are there downsides of Self Monitoring?

Self-monitoring using glucose meters is usually accurate but could be frustrating when there is significant variability in results. Inaccurate readings can be caused by the use of expired strips, improper storage of strips (exposure to high temperature and humidity), inadequate cleansing of your skin, and ingestion of vitamin C and acetaminophen.

 How to Check Your Blood Glucose

The instructions on how to use a glucose meter are usually in the package, however, these general guidelines could help!

• Wash your hands thoroughly with soap and water and dry.
• Insert the test strip into the glucometer.
• Insert the lancet (needle) into the lancing device.
• Prick the end of a finger and gently squeezing.
• Apply the blood to the test strip.
• Wait for a few seconds and note readings.
• Dispose of the used strip(s) and lancet appropriately.

Self Care Tips

• Aim to achieve a healthy weight: it is necessary to achieve a healthy weight as this brings you a step closer to their goal of controlling glucose level and reduces the risks of complications. Be mindful of the type, the quantity, and quality of your carb intake, reduce foods high in added sugars and saturated/ trans-fat and increase your dietary fiber. Findings suggest that making dietary adjustments can help lower glycated hemoglobin levels by 0.3 to 2%. You can work with your dietitian to facilitate these dietary adjustments especially in the area of carb counting.
• Be physically active: exercising regularly can help regulate hormones responsible for blood glucose control by increasing insulin sensitivity and reducing insulin resistance. A particular study observed that getting involved in a structured exercise program for at least two months helped to lower glucose levels in individuals living with type 2 diabetes. also, breaking up sedentary positions(such as sitting) and moving around every 30minutes – 1 hour could also help stay active.
• Adopt a healthy lifestyle habit: people with diabetes who smoke or drink lots of alcohol find it very difficult to control their blood glucose level compared to those who do not smoke or drink alcohol. Quitting smoking and reducing alcohol intake is the most effective way to improve your health.
• Adhere to prescribed medication or insulin shots: Adhering to prescribed medications and shots of insulin by your doctor helps to keep your blood sugar under proper control. If you start getting lower blood glucose level readings, speak with your doctor on reviewing your medications.
• Watch out for signs of hypoglycemia: with diabetes, a severe drop in blood glucose level may happen even when things are seemingly done right. It is advisable to note the signs early of low blood sugar which commonly occur together. These signs include; dizziness, disorientation, hunger, confusion, anxiety, profuse sweating, cold hands, and feet. Foods that can be used to treat hypoglycemia include 15–20 g of glucose (three glucose tablets); a piece of white bread; 1 tablespoon of table sugar (dissolved in water); 1/2 cup of juice or regular soft drink; or 1/2 cup of fat-free milk.
• Be careful not to get hurt: people with diabetes may experience slow wound healing due to poor blood circulation which is very common in those with uncontrolled diabetes, it is, therefore, important to avoid sores especially at the lower extremities such as the foot. Keeping the blood glucose within tight control will prevent nerve damage (neuropathy) and reduce the risk of slow healing.

Summary

Diabetes cannot be cured but can be self-managed involving strict adherence to medications and dietary recommendations. Blood glucose monitoring is one of the self-care tools for managing diabetes and when properly done can help to improve blood glucose control.

References

• Beck, J., et al.(2017). 2017 National standards for diabetes self-management education and support
• Colberg, S. R., et al.(2016). Physical activity/exercise and diabetes: A position statement of the American Diabetes Association.
• Lifestyle management: Standards of medical care in diabetes — 2019. (2019).
  https://care.diabetesjournals.org/content/diacare/42/Supplement_1/S46.full.pdf
• Poolsup N, Suksomboon N, Rattanasookchit S. Meta-Analysis of the benefits of self-monitoring of blood glucose on glycemic control in type 2 diabetes patients: an update. Diabetes Technol Ther. 2009;11(12):775–784
• Hirsch IB, Bode BW, Childs BP, Close KL, Fisher WA, Gavin JR, Ginsberg BH, Raine CH, Verderese CA. Self-monitoring of blood glucose (SMBG) in insulin- and non-insulin-using adults with diabetes: consensus recommendations for improving SMBG accuracy, utilization, and research. Diabetes Technol Ther. 2008;10(6):419–439.
• https://hopkinsdiabetesinfo.org/self-monitoring-of-blood-glucose/
• Monitoring Your Blood Sugar. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/diabetes/managing/managing-blood-sugar/bloodglucosemonitoring.html.
• Blood glucose test strips for patients with type 2 diabetes mellitus. PrescQIPP Bulletin. 2013;46.