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Blood Glucose Testing - Clinical Skills OSCE - Diabetic Testing - Health Assessment - Dr GillHyperglycemia monitoring -
A1C is a valuable indicator of treatment effectiveness and should be measured at least every 3 months when glycemic targets are not being met and when diabetes therapy is being adjusted or changed.
Testing at 6-month intervals may be considered in situations where glycemic targets are consistently achieved 4,7. In some circumstances, such as when significant changes are made to therapy, or during pregnancy, it is appropriate to check A1C more frequently see Diabetes and Pregnancy chapter, p.
A1C may also be used for the diagnosis of diabetes in adults see Screening for Diabetes in Adults chapter, p. Although there are some advantages to reporting in SI units, the most notable disadvantage is the massive education effort that would be required to ensure recognition and adoption of the new units.
Glycated Hemoglobin Conversion Chart for conversion of A1C from NGSP units to IFCC SI units. Point-of-care A1C analyzers are bench-top instruments that use a finger-prick capillary blood sample. They are designed for use in a health-care provider's office, a treatment room or at a bedside.
The blood is applied to a test cartridge and the sample is analyzed within several minutes Point-of-care A1C testing has several potential advantages over laboratory A1C testing, including rapid test results to expedite medical decision-making, convenience for people with diabetes, potential improved health system efficiency and improved access to testing for underserved populations A number of point-of-care A1C devices are commercially available for monitoring glycemic control; however, a United Kingdom systematic review concluded that evidence of the impact of using point-of-care A1C testing on medication use, clinical decision-making and participants' outcomes is lacking, and that a randomized trial with economic evaluation is needed Currently, no point-of-care A1C analyzers are approved for the diagnosis of diabetes.
Several studies have shown that A1C concentrations are higher in some ethnic groups African, Asian, Hispanic than in Caucasian persons with similar plasma glucose concentrations 14— In 1 cross-sectional study, A1C was 0.
However, all of these studies estimated mean glucose levels on the basis of very limited measurements and, as a result, it is not clear whether the higher A1C observed in certain ethnic groups is due to worse glycemic control or racial variation in the glycation of hemoglobin. If differences in A1C between ethnic groups exist, the differences appear to be small and have not been shown to significantly modify the association between A1C and cardiovascular outcomes 20 , retinopathy 21 or nephropathy Monitoring blood glucose levels, whether using traditional self monitoring of blood glucose SMBG devices or more recent flash glucose monitoring FGM , can serve as a useful adjunct to other measures of glycemia, including A1C.
Most people with diabetes benefit from monitoring BG for a variety of reasons 23, Monitoring BG is the optimal way to confirm and appropriately treat hypoglycemia. It can provide feedback on the results of healthy behaviour interventions and antihyperglycemic pharmacological treatments.
It can increase one's empowerment and adherence to treatment. It can also provide information to both the person with diabetes and their diabetes health-care team to facilitate longer-term treatment modifications and titrations as well as shorter-term treatment decisions, such as insulin dosing for people with type 1 or type 2 diabetes.
Finally, in situations where A1C does not accurately reflect glycemia Table 1 , monitoring BG is necessary to adequately monitor glycemia Monitoring BG is most effective when combined with an education program that incorporates instruction for people with diabetes on healthy behaviour changes in response to BG values and for health-care providers on how to adjust antihyperglycemic medications in response to BG readings 26— As part of this education, people with diabetes should receive instruction on how and when to perform self-monitoring; how to record the results in an organized fashion; the meaning of various BG levels and how behaviour and actions affect BG results.
The recommended frequency of monitoring BG may be individualized to each person's unique circumstances. Factors influencing this recommendation include type of diabetes, type of antihyperglycemic therapy, changes to antihyperglycemic therapy, adequacy of glycemic control, literacy and numeracy skills, propensity to hypoglycemia, awareness of hypoglycemia, occupational requirements and acute illness.
For people with type 1 diabetes, monitoring BG is essential to achieving and maintaining good glycemic control. The evidence is less certain in people with type 2 diabetes treated with insulin, although the above principle likely applies 8. In a large, non-randomized study of individuals with stable type 2 diabetes using insulin, testing at least 3 times a day was associated with improved glycemic control More frequent testing, including preprandial and 2-hour postprandial PG 31,32 and occasional overnight BG measurements, is often required to provide the information needed to reduce hypoglycemia risk, including unrecognized nocturnal hypoglycemia 33— For people with type 2 diabetes treated with healthy behaviour interventions, with or without noninsulin antihyperglycemic agents, the effectiveness and frequency of monitoring BG in improving glycemic control is less clear 23,24,38— A series of recent meta-analyses, all using different methodologies and inclusion criteria, have generally shown a small benefit to reducing A1C in those individuals performing SMBG compared to those who did not 48— The magnitude of the benefit is small, with absolute A1C reductions ranging from 0.
SMBG has been demonstrated to be most effective in persons with type 2 diabetes within the first 6 months after diagnosis Also of significance, there is no evidence that SMBG affects one's satisfaction, general well-being or general health-related quality of life Several recent, well-designed randomized controlled trials that have included this component have demonstrated reductions in A1C 30,57, Significantly more structured testing group participants received a treatment change recommendation compared with active control group participants.
In the Role of Self-Monitoring of Blood Glucose and Intensive Education in Patients with Type 2 Diabetes Not Receiving Insulin ROSES trial, participants were randomly allocated to either a self-monitoring-based diabetes management strategy with education on how to modify health behaviours according to SMBG readings or to usual care Results of SMBG were discussed during monthly telephone contact.
In the St. Carlos trial, newly diagnosed people with type 2 diabetes were randomized to either an SMBG-based intervention or an A1C-based intervention In the SMBG intervention group, SMBG results were used as both an educational tool to promote adherence to healthy behaviour modifications as well as a therapeutic tool for adjustment of antihyperglycemic pharmacologic therapy.
Treatment decisions for the A1C cohort were based strictly on A1C test results. After 1 year of follow up, median A1C level and body mass index BMI were significantly reduced in participants in the SMBG intervention group from 6.
In the A1C-based intervention group, there was no change in median A1C or BMI. The evidence is less clear about how often, once recommended, SMBG should be performed by persons with type 2 diabetes not treated with insulin.
Separate from the ability of the person with diabetes to use self-monitored glucose to lower A1C, monitoring glucose should be considered for the prevention, recognition and treatment of hypoglycemia in persons whose regimens include an insulin secretagogue due to the higher risk of hypoglycemia with this class of antihyperglycemic agents On the other hand, for people with type 2 diabetes who are managed with healthy behaviour interventions, with or without non-insulin antihyperglycemic agents associated with low risk of hypoglycemia, and who are meeting glycemic targets, very infrequent monitoring may be needed see Appendix 5.
Self-Monitoring of Blood Glucose [SMBG] Recommendation Tool for Health-Care Providers. Variability can exist between BG results obtained using SMBG devices and laboratory testing of PG.
In order to ensure accuracy of SMBG, results should be compared with a laboratory measurement of FPG at least annually or when A1C does not match SMBG readings. Periodic re-education on correct SMBG technique may improve the accuracy of SMBG results 61, In rare situations, therapeutic interventions may interfere with the accuracy of some SMBG devices.
For example, icodextrin-containing peritoneal dialysis solutions may cause falsely high readings in meters utilizing glucose dehydrogenase. Care should be taken to select an appropriate meter with an alternative glucose measurement method in such situations.
Meters are available that allow SMBG using blood samples from sites other than the fingertip forearm, palm of the hand, thigh. Accuracy of results over a wide range of BG levels and during periods of rapid change in BG levels is variable across sites. During periods of rapid change in BG levels e.
after meals, after exercise and during hypoglycemia , fingertip testing has been shown to more accurately reflect glycemic status than forearm or thigh testing 63, In comparison, blood samples taken from the palm near the base of the thumb thenar area demonstrate a closer correlation to fingertip samples at all times of day and during periods of rapid change in BG levels 65, If all of these conditions are present in type 2 diabetes, ketone testing should be considered, as DKA also can occur in these individuals.
During DKA, the equilibrium that is usually present between ketone bodies shifts toward formation of beta-hydroxybutyric acid beta-OHB. As a result, testing methods that measure blood beta-OHB levels may provide more clinically useful information than those that measure urine acetoacetate or acetone levels.
Assays that measure acetoacetate through urine testing may not identify the onset and resolution of ketosis as quickly as those that quantify beta-OHB levels in blood, since acetoacetate or acetone can increase as beta-OHB decreases with effective treatment Meters that quantify beta-OHB from capillary sampling may be preferred for self-monitoring of ketones, as they have been associated with earlier detection of ketosis and may provide information required to prevent progression to DKA 66— This may be especially useful for individuals with type 1 diabetes using continuous subcutaneous insulin CSII therapy, as interruption of insulin delivery can result in rapid onset of DKA Continuous glucose monitoring CGM systems measure glucose concentrations in the interstitial fluid.
Two types of devices are available. CGM technology incorporates a subcutaneously inserted sensor, an attached transmitter and, in the case of real-time CGM, a display unit which may be a stand-alone unit or be integrated into an insulin pump.
In Canada, 2 real-time CGM and 2 professional CGM are available. Real-time CGM has been consistently shown to reduce A1C in both adults 70—81 and children 71,73,75,76,78,79,82 with type 1 diabetes with and without CSII, and to reduce A1C in adults with type 2 diabetes Real-time CGM also has been shown to reduce the time spent in hypoglycemia 78,80,81, Professional CGM has been shown to reduce A1C in adults with type 2 diabetes 85 and in pregnant women with type 1 or type 2 diabetes Successful use of CGM is dependent on adherence with duration of time the CGM is used.
The greater the time wearing the device, typically the better the A1C 72,73,76,77,82, Like SMBG, CGM provides the best outcomes if it is associated with structured educational and therapeutic programs.
CGM is not a replacement for SMBG because SMBG is still required for calibration of the CGM device. Some real-time CGM devices require SMBG to confirm interstitial measurements prior to making therapeutic changes or treating suspected hypoglycemia; whereas other devices only require SMBG if glucose alerts and readings do not match symptoms.
Flash glucose monitoring FGM also measures glucose concentration in the interstitial fluid, however, FGM differs from CGM technology in several ways.
FGM is factory calibrated and does not require capillary blood glucose with SMBG device calibration. The FGM reader also displays a plot profile of the last 8 hours, derived from interpolating glucose concentrations recorded every 15 minutes.
The sensor can be worn continuously for up to 14 days. The device does not provide low or high glucose alarms. In the Randomised Controlled Study to Evaluate the Impact of Novel Glucose Sensing Technology on HbA1c in Type 2 Diabetes trial, in individuals with type 2 diabetes, the use of FGM vs.
A1C, glycated hemoglobin ; BG, blood glucose; BMI , body mass index CBG ; capillary blood glucose; CGM , continuous glucose monitoring; CGMS , continuous glucose monitoring system; CSII , continuous subcutaneous infusion infusion; DKA , diabetic ketoacidosis; FGM ; flash glucose monitoring; FPG , fasting plasma glucose; PG , plasma glucose; SMBG , self-monitoring of blood glucose.
Appendix 5. Self-Monitoring of Blood Glucose SMBG Recommendation Tool for Health-Care Providers. Literature Review Flow Diagram for Chapter 9: Monitoring Glycemic Control. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses: The PRISMA Statement.
PLoS Med 6 6 : e pmed For more information, visit www. Rick Siemens reports personal fees from Sanofi, Novo Nordisk, Mont-Med, Abbott, Merck, AstraZeneca, Lifescan, and Janssen, outside the submitted work.
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Chapter Headings A1C Testing Self-Monitoring of Blood Glucose Ketone Testing Continuous Glucose Monitoring Systems Flash Glucose Monitoring Other Relevant Guidelines Relevant Appendices Author Disclosures.
Key Messages Glycated hemoglobin A1C is a valuable indicator of glycemic treatment effectiveness and should be measured at least every 3 months when glycemic targets are not being met and when antihyperglycemic therapy is being adjusted.
In some circumstances, such as when significant changes are made to therapy or during pregnancy, it is appropriate to check A1C more frequently.
Awareness of all measures of glycemia—self-monitored blood glucose results, including self-monitored blood glucose SMBG , flash glucose monitoring FGM , continous glucose monitoring CGM and A1C—provides the best information to assess glycemic control.
Self-monitoring of blood glucose, FGM and CGM should not be viewed as glucose-lowering interventions, but rather as aids to assess the effectiveness of glucose-lowering interventions and to prevent and detect hypoglycemia.
Timing and frequency of SMBG may be determined individually based on the type of diabetes, the type of antihyperglycemic treatment prescribed, the need for information about blood glucose levels and the individual's capacity to use the information from testing to modify healthy behaviours or self-adjust antihyperglycemic agents.
SMBG, FGM and CGM linked with a structured educational and therapeutic program designed to facilitate behaviour change can improve blood glucose levels and prevent hypoglycemia. Key Messages for People with Diabetes A1C is a measurement of your average blood glucose control for the last 2 to 3 months.
You should have your A1C measured every 3 months when your blood glucose targets are not being met or when you are making changes to your diabetes management.
In some circumstances, such as when significant changes are made to your glucose-lowering therapy or during pregnancy, your health-care provider may check your A1C more frequently. Checking your blood glucose with a glucose meter also known as self-monitoring of blood glucose or using a flash glucose meter or continuous glucose monitor will: Determine if you have a high or low blood glucose at a given time Show how your health behaviours and diabetes medication s affect your blood glucose levels Help you and your diabetes health-care team to make health behaviour and medication changes that will improve your blood glucose levels.
Discuss with your diabetes health-care team how often you should check your blood glucose level. A1C Testing Glycated hemoglobin A1C is a reliable estimate of mean plasma glucose PG levels over the previous 8 to 12 weeks 1.
Self-Monitoring of Blood Glucose Monitoring blood glucose levels, whether using traditional self monitoring of blood glucose SMBG devices or more recent flash glucose monitoring FGM , can serve as a useful adjunct to other measures of glycemia, including A1C.
Frequency of SMBG The recommended frequency of monitoring BG may be individualized to each person's unique circumstances.
Type 1 and type 2 diabetes treated with insulin For people with type 1 diabetes, monitoring BG is essential to achieving and maintaining good glycemic control. Type 2 diabetes not treated with insulin For people with type 2 diabetes treated with healthy behaviour interventions, with or without noninsulin antihyperglycemic agents, the effectiveness and frequency of monitoring BG in improving glycemic control is less clear 23,24,38— Verification of accuracy of SMBG performance and results Variability can exist between BG results obtained using SMBG devices and laboratory testing of PG.
Alternate site testing Meters are available that allow SMBG using blood samples from sites other than the fingertip forearm, palm of the hand, thigh. Continuous Glucose Monitoring Systems Continuous glucose monitoring CGM systems measure glucose concentrations in the interstitial fluid. Flash Glucose Monitoring Flash glucose monitoring FGM also measures glucose concentration in the interstitial fluid, however, FGM differs from CGM technology in several ways.
Recommendations For most individuals with diabetes, A1C should be measured approximately every 3 months to ensure that glycemic goals are being met or maintained [Grade D, Consensus].
In some circumstances, such as when significant changes are made to therapy, or during pregnancy, it is appropriate to check A1C more frequently. Testing at least every 6 months should be performed in adults during periods of treatment and healthy behaviour stability when glycemic targets have been consistently achieved [Grade D, Consensus].
For individuals using insulin more than once a day, SMBG should be used as an essential part of diabetes self-management [Grade A, Level 1 34 , for type 1 diabetes; Grade C, Level 3 23 , for type 2 diabetes] and should be undertaken at least 3 times per day [Grade C, Level 3 23,31 ] and include both pre- and postprandial measurements [Grade C, Level 3 31,32,89 ].
For individuals with type 2 diabetes on once-daily insulin in addition to noninsulin antihyperglycemic agents, testing at least once a day at variable times is recommended [Grade D, Consensus].
For individuals with type 2 diabetes not receiving insulin therapy, frequency of SMBG recommendations should be individualized depending on type of antihyperglycemic agents, level of glycemic control and risk of hypoglycemia [Grade D, Consensus].
When glycemic control is not being achieved, SMBG should be instituted [Grade B, Level 2 46,51 ] and should include periodic pre- and postprandial measurements and training of health-care providers and people with diabetes on methods to modify health behaviours and antihyperglycemic medications in response to SMBG values [Grade B, Level 2 30,90 ] If achieving glycemic targets or receiving antihyperglycemic medications not associated with hypoglycemia, infrequent SMBG is appropriate [Grade D, Consensus].
In many situations, for all individuals with diabetes, more frequent SMBG testing should be undertaken to provide information needed to make health behaviour or antihyperglycemic medication adjustments required to achieve desired glycemic targets and avoid risk of hypoglycemia [Grade D, Consensus].
In people with type 1 diabetes who have not achieved their glycemic target, real-time CGM may be offered to improve glycemic control [Grade A, Level 1A 71,80,81 for non-CSII users; Grade B, Level 2 for CSII users 71 ] and reduce duration of hypoglycemia [Grade A, Level 1A 78,80,84 ] in individuals who are willing and able to use these devices on a nearly daily basis.
FGM may be offered to people with diabetes to decrease time spent in hypoglycemia [Grade B, Level 2 87 for type 1 diabetes; Grade B, Level 2 88 for type 2 diabetes]. In order to ensure accuracy of BG meter readings, meter results should be compared with laboratory measurement of simultaneous venous FPG 8-hour fast at least annually and when A1C does not match glucose meter readings [Grade D, Consensus].
Blood ketone testing methods may be preferred over urine ketone testing, as they have been associated with earlier detection of ketosis and response to treatment [Grade B, Level 2 67 ].
Abbreviations: A1C, glycated hemoglobin ; BG, blood glucose; BMI , body mass index CBG ; capillary blood glucose; CGM , continuous glucose monitoring; CGMS , continuous glucose monitoring system; CSII , continuous subcutaneous infusion infusion; DKA , diabetic ketoacidosis; FGM ; flash glucose monitoring; FPG , fasting plasma glucose; PG , plasma glucose; SMBG , self-monitoring of blood glucose.
Other Relevant Guidelines Chapter 7. Self-Management Education and Support Chapter 8. Targets for Glycemic Control Chapter Glycemic Management in Adults with Type 1 Diabetes Chapter Hypoglycemia Chapter Type 1 Diabetes in Children and Adolescents Chapter Type 2 Diabetes in Children and Adolescents Chapter Diabetes and Pregnancy.
Relevant Appendices Appendix 5. Self-Monitoring of Blood Glucose SMBG Recommendation Tool for Health-Care Providers Appendix Glycated Hemoglobin Conversion Chart. References McCarter RJ, Hempe JM, Chalew SA. Mean blood glucose and biological variation have greater influence on HbA1c levels than glucose instability: An analysis of data from the Diabetes Control and Complications Trial.
Diabetes Care ;—5. Goldstein DE, Little RR, Lorenz RA, et al. Tests of glycemia in diabetes. Diabetes Care ;— Calisti L, Tognetti S. Measure of glycosylated hemoglobin. Acta Biomed ;76 Suppl. American Diabetes Association.
Standards of medical care in diabetes— Diabetes Care ;30 Suppl. Sacks DB, Bruns DE, Goldstein DE, et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem ;— American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and LaboratoryMedicine, International Diabetes Federation.
Consensus statement on the worldwide standardisation of the HbA1c measurement. Diabetologia ;—3. Driskell OJ, Holland D,Waldron JL, et al. Reduced testing frequency for glycated hemoglobin, HbA1c, is associated with deteriorating diabetes control.
Diabetes Care ;—7. Consensus Committee. Consensus statement on the worldwide standardization of the hemoglobin A1C measurement: The American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and Laboratory Medicine, and the International Diabetes Federation.
Sacks DB. Measurement of hemoglobin A 1c : A new twist on the path to harmony. Weykamp C, JohnWG, Mosca A, et al. The IFCC Reference Measurement System for HbA1c: A 6-year progress report.
Clin Chem ;—8. Diagnostic Evidence Co-operative Oxford. Point-of-care HbA1c tests—diagnosis of diabetes. London: National Institue for Health Research NHS , , pg.
Report No. Accessed November 15, Spaeth BA, Shephard MD, Schatz S. Point-of-care testing for haemoglobin A1c in remote Australian Indigenous communities improves timeliness of diabetes care. Rural Remote Health ; Hirst JA, McLellan JH, Price CP, et al.
Performance of point-of-care HbA1c test devices: Implications for use in clinical practice—a systematic review and metaanalysis. Clin Chem Lab Med ;— Saaddine JB, Fagot-Campagna A, Rolka D, et al.
Distribution of HbA 1c levels for children and young adults in the U. Herman WH, Ma Y, Uwaifo G, et al. Differences in A1C by race and ethnicity among patients with impaired glucose tolerance in the Diabetes Prevention Program. Herman WH, Dungan KM, Wolffenbuttel BH, et al.
Racial and ethnic differences in mean plasma glucose, hemoglobin A1c, and 1,5-anhydroglucitol in over patients with type 2 diabetes. J Clin Endocrinol Metab ;— Selvin E, Steffes MW, Ballantyne CM, et al.
Racial differences in glycemic markers: A cross-sectional analysis of community-based data. If the results differ by more than 15 percent, there may be a problem with your meter or other equipment; your provider can help you figure out what's going on and how to correct the problem.
Help for people with vision impairment — People with vision impairment a common complication of diabetes sometimes have difficulty using glucose meters. Meters with large screens and "talking" meters are available. If you have impaired vision, you can get help from the American Association of Diabetes Care and Education Specialists ADCES at Continuous glucose monitoring CGM is a way to monitor your glucose levels every 5 to 15 minutes, 24 hours a day.
Because of reliability issues, warm-up periods, and the need to calibrate some of the devices, CGM does not eliminate the need for at least occasional fingersticks.
CGM systems are described in detail above see 'Continuous glucose monitoring' above. Who should use CGM?
CGM systems are most often used by people with type 1 diabetes. Periodic use of CGM can also help you and your health care provider determine when your glucose is low or high and how to adjust your medication doses or food intake to prevent these fluctuations.
Devices that combine an insulin pump with a CGM system are also available. See "Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics ". Advantages — There is evidence that people with type 1 diabetes who use a CGM system consistently and reliably rather than blood glucose monitoring [BGM] have modestly better managed blood glucose levels.
The "real-time" CGM devices automatically display your glucose level every five minutes, using numbers, graphics, and arrows so you can easily tell if your level is increasing, decreasing, or stable figure 3. The receiver recording device can also be set to trigger an alarm if your glucose level gets above or below a preset level, which can be especially helpful for people who cannot feel when they have low blood glucose also known as "impaired awareness of hypoglycemia".
Most CGM systems permit real-time "sharing" of your CGM readings with others eg, family members or caregivers. Some, but not all, of these intermittently scanning CGM devices are able to alert you of low or high glucose readings.
You can download glucose results from the CGM system to your computer, tablet, or smartphone, allowing you to see glucose trends over time. If you take insulin, your health care provider can help you figure out how to use this information to adjust your insulin dose if needed.
Drawbacks — CGM systems may show lower glucose values than blood glucose meters, especially when blood glucose levels are rapidly rising. In addition, the costs associated with CGM are greater than those of traditional glucose meters.
Not all continuous glucose meters and supplies are covered by commercial health insurance companies. Glucose testing — The results of glucose testing with blood glucose monitoring BGM or continuous glucose monitoring CGM tell you how well your diabetes treatments are working.
Glucose results can be affected by different things, including your level of physical activity, what you eat, stress, and medications including insulin, non-insulin injectable medications, and oral diabetes medications. To fully understand what your glucose levels mean, it is important to consider all of these factors.
When keeping track of your results, you should include the time and date, glucose result, and the medication and dose you are taking. Additional notes about what you ate, whether you exercised, and any difficulties with illness or stress can also be helpful but are not generally required every day.
You should review this information regularly with your health care provider to understand what your results mean and whether you need to make any changes to better manage your glucose levels.
Need for urine testing — If you have type 1 diabetes, your health care provider will talk to you about checking your urine for ketones. Ketones are acids that are formed when the body does not have enough insulin to get glucose into the cells, causing the body to break down fat for energy.
Ketones can also develop during illness, if an inadequate amount of glucose is available due to skipped meals or vomiting. Ketoacidosis is a condition that occurs when high levels of ketones are present in the body; it can lead to serious complications such as diabetic coma.
Urine ketone testing is done with a dipstick, available in pharmacies without a prescription. If you have moderate to large ketones, you should call your health care provider immediately to determine the best treatment. You may need to take an additional dose of insulin, or your provider may instruct you to go to the nearest emergency room.
Meters that measure ketone levels in the blood are also available, but due to their cost, urine testing is more widely used. ADJUSTING TREATMENT. Checking your glucose either with blood glucose monitoring [BGM] or continuous glucose monitoring [CGM] provides useful information and is an important part of managing your diabetes.
If you use insulin, your glucose results will help guide you in choosing the appropriate doses from meal to meal. When you first start treatment for diabetes, you will need to work with your health care provider as you learn to make adjustments in treatment.
However, with time and experience, most people learn how to make many of these adjustments on their own. Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Type 2 diabetes The Basics Patient education: Using insulin The Basics Patient education: Treatment for type 2 diabetes The Basics Patient education: Low blood sugar in people with diabetes The Basics Patient education: Care during pregnancy for people with type 1 or type 2 diabetes The Basics Patient education: My child has diabetes: How will we manage?
The Basics Patient education: Managing blood sugar in children with diabetes The Basics Patient education: Managing diabetes in school The Basics Patient education: Hemoglobin A1C tests The Basics Patient education: Giving your child insulin The Basics Patient education: Checking your child's blood sugar level The Basics Patient education: Diabetic ketoacidosis The Basics Patient education: Hyperosmolar hyperglycemic state The Basics Patient education: Diabetes and infections The Basics.
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Type 1 diabetes: Overview Beyond the Basics Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics Patient education: Type 2 diabetes: Overview Beyond the Basics.
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings.
These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus Measurements of chronic glycemia in diabetes mellitus Overview of the management of type 1 diabetes mellitus in children and adolescents Treatment of type 2 diabetes mellitus in the older patient.
org , available in English and Spanish. Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Patient education: Glucose monitoring in diabetes Beyond the Basics.
Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. Author: Ruth S Weinstock, MD, PhD Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD Contributor Disclosures. All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jan This topic last updated: Apr 06, GLUCOSE TESTING OVERVIEW If you have diabetes, you have an important role in your own medical care and monitoring your glucose sugar level is a key part of this. FREQUENCY OF GLUCOSE TESTING Studies have proven that people with diabetes who maintain normal or near-normal blood glucose levels reduce their risk of diabetes-related complications.
ADJUSTING TREATMENT Checking your glucose either with blood glucose monitoring [BGM] or continuous glucose monitoring [CGM] provides useful information and is an important part of managing your diabetes. The Basics Patient education: Managing blood sugar in children with diabetes The Basics Patient education: Managing diabetes in school The Basics Patient education: Hemoglobin A1C tests The Basics Patient education: Giving your child insulin The Basics Patient education: Checking your child's blood sugar level The Basics Patient education: Diabetic ketoacidosis The Basics Patient education: Hyperosmolar hyperglycemic state The Basics Patient education: Diabetes and infections The Basics Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.
Patient education: Type 1 diabetes: Overview Beyond the Basics Patient education: Care during pregnancy for patients with type 1 or 2 diabetes Beyond the Basics Patient education: Type 2 diabetes: Overview Beyond the Basics Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings.
Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus Measurements of chronic glycemia in diabetes mellitus Overview of the management of type 1 diabetes mellitus in children and adolescents Treatment of type 2 diabetes mellitus in the older patient The following organizations also provide reliable health information.
org , available in English and Spanish [ ]. Translating the A1C assay into estimated average glucose values. Diabetes Care ; ElSayed NA, Aleppo G, Aroda VR, et al.
Diabetes Technology: Standards of Care in Diabetes Diabetes Care ; S Machry RV, Rados DV, Gregório GR, Rodrigues TC. Self-monitoring blood glucose improves glycemic control in type 2 diabetes without intensive treatment: A systematic review and meta-analysis.
Blood glucose monitoring can monitring you to keep Hypegglycemia blood glucose level in your recommended target Hyperglcyemia. The number RMR and body composition yHperglycemia a day you check your Low-carb weight control will Antioxidant rich juices on what type of treatment you are RMR and body composition e. Your diabetes team can advise when and how often to monitor. In general, you can check:. Structured self-monitoring involves checking your blood glucose levels at certain times of the day for instance after meals for a given period i. two weeks and then working with your diabetes healthcare team to figure out how food, physical activity and medications are impacting your blood glucose levels. Glucose levels can be monitored using a blood glucose meter, Flash Glucose Monitor Flash GM or Continuous Glucose Monitor CGM.
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