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Living with Diabetes
Monitoring of blood glucose levels and also monitoring of
other blood chemistry tests together with monitoring for any
alarming symptoms or signs are the corner stone of proper
living with diabetes . blood glucose testing is essential for
all people with diabetes. Typically a person measures their own
glucose level with a meter and strips at homewhich is called
Self Monitoring of Blood Glucose SMBG . its aim
is to achieve an optimal glucose level nearer to the
normal level as much as possible. testing is very important
because the blood sugar level cannot be accurately
determined by symptoms alone , so we should never rely on the
symptoms and signs related to hyperglycemia to define if the
blood sugar is normal or abnormal , the only tool to know the
blood glucose level is simply to measure it
.
Monitoring of blood glucose levels should be
frequent and continuous as far as possible and so arising the
importance of taking charge management which means that the
patients should have an active role in controlling the blood
glucose levels . Testing blood sugar often is the main mission
of this management
policy , however still there is a need to test more than just
blood sugar. some tests usually done by the doctor or the lab
like Hemoglobin or
A1C testing, which gives an impression about the average blood
sugar level over the last 3 months; also there is a need for
ketone testing, which is an indicator for ketoacidosis.
also continuous measurement of weight, blood pressure and blood
fats are of great importance .
Again
blood sugar levels either high or low could not at all be
suggested only by symptoms and signs , many people think they
can tell what their blood sugar is by how they feel and this
is absolutely wrong. Some people can feel
"high" when their blood sugar is low, and some can
feel "low" when their blood sugar is normal or high.
The only way to know for sure is to measure the blood sugar.
testing also reflects the effects of various factors on blood
glucose levels such as behavior , exercise , eating ….etc
The most recent and important studies support
the fact that prevention and minimizing complications are
strongly related to the good control of blood glucose which is
achieved by proper management and frequent testing .
* Diabetes Control and Complications Trial
DCCT
* The United Kingdom Prospective Diabetes Study
UKPDS
* The Kumamoto Study
The Kumamoto study was for people with type 2 diabetes. This study had similar results to the DCCT. People with good control had fewer problems with their eyes, kidneys and nerve damage.
| Blood Glucose Level Targets: |
| Pre-meals |
80-120 mg/dl |
| Post-meals--2 hours less than |
180 mg/dl |
| Bedtime |
100-140 mg/dl |
How often testing is required ?
The frequency and timing of tests will vary depending on an individual's basis , type of therapy ( insulin , tablets or both ) , goals of that therapy ( conventional or intensive ) , and the presence or absence of the complications . the changes in food, exercise, medications, illness, or travel usually need more testing .
- Type
1: before meals and bedtime, 1-2 hours after meals and during night as needed.
- Type
2: before meals and/or bedtime, 1-2 hours after meals as needed.
Before testing, have your health care provider show you the best techniques. When testing be sure to follow the manufacturer's directions and these helpful suggestions:
- Wash your hands (anything on your hands can change the reading).
- Collect the amount of blood required.
- Test again if reading seems incorrect. Use another meter to double check.
- Clean your meter as often as required.
- Record and date/time your test results
Here are some tips for accurate readings:
- Be sure to match the code on the meter or the meter's code chip with the code on the strip container.
- Check the date on the strips for freshness.
- Store strips so they don't deteriorate (protect from heat, light, and humidity)
- Check for low battery if results aren't accurate
Be sure to keep a good record of all tests. Discuss blood glucose goal ranges with your health care provider. Discuss how and when to make changes to your diabetes care--food, exercise, medications, insulin doses.
A hemoglobin A1c test is a simple lab test that shows the average blood sugar level for the past two to three months
HbA1c , A1C
As mentioned before that home blood glucose testing is accurate and should be performed as frequent as possible , yet despite it is accurate , yet the main disadvantage that it is momentary , as it reflects the blood glucose level only at that moment regardless what was the case hours or days before , and because keeping diabetes in good control is the key to staying healthy. so checking blood sugar levels at different times of the day should be done to make sure that diabetes plan is working. These tests tell you what your blood sugar level is at that moment, which is very helpful. However, still there is a need to know about the state off blood sugar along the past months to judge the success of the diabetes management plan as just mentioned estimation of blood glucose ALONE does not give the whole image.
There is another test that can tell you your average blood sugar level over the last 2 to 3 months. This laboratory test is called a hemoglobin A1C. You may hear a few different names for it, including:
- HbA1C or HbA1C
- Glycohemoglobin
- A1C or A1C
Note: In August 2001, the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) recommended that hemoglobin A1C be referred to as the "A1C". We will use this reference from here on
Ketone testing
this test is very important especially in children and all diabetics who are prone to ketoacidosis , Ketone testing involves checking how many ketones, or acids are in your bloodstream so you can make sure your body isn't burning fat instead of sugar and avoid a medical emergency, called ketoacidosis, which can lead to coma or death. Ketones are a type of acid that are left over when your body burns some of its own fat for fuel. Your body burns fat if it can't get enough sugar (glucose) to use for energy. When your body burns too much fat too quickly, there may be ketones in your blood. Ketones get removed from your bloodstream into your urine. People with type 1 diabetes develop ketones more easily than people with type 2 diabetes. Everyone with type 1 diabetes should test for ketones in their urine. People with type 2 diabetes are less likely to have problems with ketones, but everyone with diabetes should know about the warning signs and when to test. Ketone testing, like blood sugar testing, is very important. Finding ketones in your urine is a sign of trouble
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