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Self-Monitoring of Blood Glucose
A home blood glucose monitor-a device that analyzes a blood sample and gives you a reading of your current blood sugar levels-is the next best thing to having a lab in your medicine cabinet. Monitors (also called meters), are probably the single most useful tool you have for knowing what's going on with your diabetes, mainly because they are always accessible, provide instant results, and don't require a trip to the doctor's office.
Regular self-monitoring of blood glucose levels (SMBG) gives you a quick clinical snapshot of exactly where your blood glucose levels are at any given moment. Testing, and keeping a detailed log of test results and the circumstances that surround them, will help you understand how certain foods and activities impact your blood sugar. Once you are able to detect patterns in blood glucose changes over time, you can use the information to adjust your treatment accordingly.
I can't stand the thought of sticking myself. Can't I just test for sugar in my urine? You could, but it would do little to help you control your diabetes. Urine glucose testing was the way it was done before home glucose monitors became commonplace. But because urine collects in your bladder for several hours before it leaves the body and only contains glucose when blood levels are over 180 mg/dl, it isn't a very timely or sensitive test. Worse, it cannot help detect potentially dangerous low blood sugar levels.
The Diabetes Control and Complications Trial (DCCT), a landmark clinical study that took place in medical centers across the U.S. in the early 1990s, found that tight control of blood glucose levels using SMBG significantly reduced the risk of diabetes-related complications. Since the study was published in 1993, the ADA has developed guidelines on SMBG and home testing has become a recommended, routine care practice. Another role of SMBG is to help you assess how effective your medication or insulin is in controlling your glucose levels. It is also an invaluable tool for adjusting the timing of medication to ensure the best possible control.
Perhaps most importantly, SMBG can help you avoid life-threatening blood sugar emergencies. If you are under stress, sick with the flu, or taking medications that affect blood glucose levels, regular testing can help you keep close tabs on your blood sugar levels to take action before they go dangerously high.
Testing before, after, and possibly during exercise can help you avoid a precipitous drop in blood glucose levels. It's also wise to test if you've been drinking alcohol, another trigger for hypoglycemia. If you feel a low coming on, a quick test can confirm your levels so you can take action immediately.
Home glucose testing is particularly important for people with a condition known as hypoglycemic unawareness. These individuals have lost the ability to perceive the normal warning signs that blood sugars are dropping too low-such as shakiness, anxiety, confusion, dizziness, irritability, and rapid heartbeat. Without testing, they may lose consciousness before realizing they are experiencing a hypoglycemic episode.
Developing a Testing Schedule
When to test is a matter of debate. Some people test once when they wake up. Others test up to eight times a day-morning, night, and before and after meals. As a general rule, when your diagnosis is new and you're learning how different factors affect your diabetes, checking your glucose levels frequently is encouraged. The same holds true for monitoring any changes to your treatment routine.
People with type 1 diabetes may need to test more than those with type 2, since they need to use the results to adjust insulin accordingly. And people with glucose levels that fluctuate widely, often without warning (a condition known as brittle diabetes), may also need to test more frequently than others.
When determining a schedule for blood glucose testing with your doctor, make sure you discuss any financial or insurance issues that may impact your testing routine. Test strips are expensive (they may cost more than the monitor itself), and some insurance plans put a cap on the quantity of testing supplies they will cover for a given time period. Find out what your insurer offers and work from there. In some cases, your provider may be able to offer you some free product samples to augment your supply.