(copied from the old board)

Posted by DJ
22 Apr 2003 : 8:12:12 PM

This is excerpted from a handout about "Monitoring BG Levels" that contains excellent information, by Ms. Sherri Shafer, RD, Certified Diabetes Educator.

Click the link at the end to read this informative (and lengthy) article, or to access Sherri's archives, (beneath her picture, on the left side of the screen).

It's ok to copy the material in toto; they intend it to be printed as handouts to DMs.


The <font color=red>portions set in red script are my comments. </font>

dj


When to test BGs:

The optimal time and frequency of SMBG (self-monitoring BGs) depends on the patient's age, type of diabetes, type and timing of medication, co-morbidities, treatment goals, and history of glycemic control.

Suggested times to check blood glucose:
<ul>
<LI>Fasting blood glucose.

<LI>Before meals.

<LI>1-2 hours after meals for peak postprandial value.
</ul>

<u> Before and after meal blood sugar checks are important to show the response to the foods eaten: </u>

<ul>
<LI>Occasionally, check at 2-3 AM, to ensure that medication doses are correct, and/or to expose nocturnal hypoglycemic episodes that may be going unnoticed.

<LI>Before and after exercise to see individual response to various forms of activity. This check provides the DM1 information for adjustments to the insulin regimen, & DM2's find it rewarding to see how exercise can improve blood sugar levels.

<LI>Before driving a car (for anyone on insulin or oral hypoglycemic agents) -- this is especially critical for teens, and for anyone with hypoglycemia unawareness, or who has a history of low blood sugar.

<LI>When experiencing symptoms of hypoglycemia.

<LI>When drinking alcohol, given the increased risk for hypoglycemia, because alcohol inhibits gluconeogenesis.

<u>
<LI>Increase the frequency of monitoring during illness.

<LI>Increase the frequency of monitoring to assess changes in therapy. </u>

</ul>


Blood glucose targets for non-pregnant individuals with diabetes:

Event Normal BG Goal Additional Action Suggested

Preprandial < 110 90-130 < 90, >150

Postprandial < 140 140-180 > 180

Bedtime < 120 110-150 < 110, >180

<font color=red> A light snack is essential at bedtime, even if you are not hungry. i've found it most effective to eat healthy fat and protein or a small kefir smoothie with pumpkin, coconut, flax meal, and stevia to taste (+/- 250 cal).

For non-diabetics,
preprandial readings are usually between 80-100;
postprandial (postmeal) readings are usually between 130-140 (unless they have really carb-loaded).
bedtime readings are usually between 80-100. i prefer to keep my levels as close to the non-diabetic ranges as possible because the blood glucose level is different is not the insulin level, which is <5 (equivalent to approximately 90) in non-diabetics.

i can get non-diabetic premeal readings because i control with diet (and exercise when physically able). DM1s, controlling w/ insulin, and DM2s who control with oral glucose agents, probably cannot because of the danger of hypos, which i never have to contend with hypos unless i am too active for too long & have forgotten to eat.

i prefer for my bedtime reading to fall between 85-100 -- esp because i've been having trouble with DP (overnight glucose rise) since July, 2002.</font>

<u>*Remember, individual targets should be established with the input of your medical provider.</u> It may be prudent to set the targets higher for certain patient populations, such as young children given the risks that hypoglycemia can affect cognitive development, the elderly who are at risk for falling,& patients with hypoglycemic unawareness or other complications.

** The above values are plasma-referenced and expressed in mg/dl. (Most blood glucose monitors are plasma referenced. For meters that provide readings as whole blood values, the numbers would be 10-15 percent lower.)

*** If you are more familiar with millimoles per liter, you can convert mg/d to mmol/l by dividing by 18.01.

Record Keeping

No one can review a meter's memory, number by number, and make sense of the information. A written logbook offers the added benefit of organizing blood sugar readings into the various times of the day. This allows both patient and health-care team to see glycemic patterns. When a reproducible pattern is observed, a treatment plan can be instituted. I advise patients to call when they notice a pattern that indicates inadequate control.

Too often, patients check their blood glucose levels, write down the numbers (or not) without using the information to problem solve. Patients have to be taught what to do with the numbers, and when to contact their healthcare providers. On the flip side, health care providers must look at the blood glucose logbooks and interact with our patients regarding the numbers. Nothing is more frustrating for patients than to keep records and then have their healthcare team ignore the data.

<font color=red> If your team ignores or does not examine your BG logs, your DM care is inadequate, because learning to do this day by day and how to spot (and to correct) problem areas is essential to your well-being. The team's input to resolve questions or problems is absolutely necessary.</font>

Computer printouts downloaded from the meter data are helpful; however, they shouldn't replace written records. If patients download their meter information on the day of the appointment, it's likely that they have not been reviewing their data on a daily and/or weekly basis, and they are less likely to see patterns of control.

<font color=red>
If you do log carefully, your records soon will ID the foods that help or hinder your blood glucose levels. It's a real chore to learn how to do it, but after you've mastered the drill, you'll reap the benefits in both the short and long term. (The long term benefit is avoiding the horrid things that can happen to DMs who fail to manage their condition well -- a long and most unpleasant list.

Too often DM caregivers say that the reason a treatment plan does not work is that the patient is not compliant -- either through lack of understanding {subtext -- stupid ; or deceitful -- lying about what they have eaten...} If you have done your best to comply, do not accept this rationalization. The team gets paid for your treatment -- see that you understand the whys and wherefores of your treatment plan. Insist on this, good care is your right, and his or her responsibility.
i promised to post this information weeks ago -- sorry it has taken this long. Next time, i'll type in the information from Joslin Diabetes Center.

Best wishes,
dj</font>[]


http://www.diabetesincontrol.com/shafer/homemon.shtml