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SIX. Monitoring and Living with Diabetes

What information should I bring to my doctor to help him or her manage my diabetes with me?

How accurate are glucose monitors?

How will my diabetes affect my work? Are there any jobs I cannot do?

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How often do I need to check my blood sugar?

How often you need to check your blood sugar depends upon how the information that blood sugar testing provides will be used. All too often, people with diabetes are instructed to test their blood sugar frequently and yet neither they nor their physician or other caregivers make significant use of the information. Generally, when treatment (such as the amount of insulin to be taken before the next meal) is not being adjusted immediately or even day to day, there is little justification for very frequent testing. Except for people who cannot or will not test, all people with diabetes should be prepared to check their blood sugar frequently when they are sick, under severe physical stress, or taking medications that are known to markedly affect the blood sugar level, such as steroids. Examples of possible glucose monitoring schedules for various circumstances are shown in Table 7.

How often you need to check your blood sugar depends upon how the Information that blood sugar testing provides will be used.

Table 7 Glucose Monitoring Strategies

Type of Diabetes

Testing Strategy

Type 1, 2, or GDM on intermittent insulin 2 to 4 times daily

Before meals, bedtime, occ. after meals, & during night

Type 1 or 2 on continuous insulin infusion (pump)

Before meals, bedtime, sometimes after meals, & during night

Type 2 on oral antidiabetic pills (OAl)s)

Before breakfast and supper alternating with before lunch and bedtime, 3 days/week

Type 2 or GDM on lifestyle intervention

As for type 2 on OADs, 1 to 3 days/week

All types, when sick or unstable

As needed to intervene effectively, q2-hours if needed

What is the target level for my blood sugar?

The target level for your blood sugar depends on who you are and on the other circumstances of your health. Various authoritative expert bodies have published blood sugar targets to aim at before and 2 hours after meals at various stages of life, including for children, adults, pregnant women, and the elderly. The various recommendations differ in certain respects, but are generally similar and those of the American Diabetes Association and the American Association of Clinical Endocrinologists are shown in Table 8. Wherever possible, otherwise healthy individuals with diabetes should aim to achieve blood sugar levels that are as close to normal as possible, as long as these can be reached without side effects that are either distressing or dangerous. This is a matter of judgment between you and your physician. The main side effects of the various pills for diabetes are shown in Tible 4 (Question 41).

The target levels for blood sugar can either be described by blood sugar levels themselves or in overall terms, according to the Hemoglobin A1c (HbA1c or A1c), which is an average measure of blood sugar over the prior 3-4 months, approximately. For all people with diabetes, but especially those who do not need to perform frequent selfmonitoring of blood sugar or who are unable to do so, the HbAlc is a very helpful measure and the American Diabetes Association recommends that it is performed at least twice per year. Recently, it has been recommended that the HbAlc should be reported in terms of the estimated average blood glucose (eAG) to which it corresponds, which may be more meaningful to most persons with diabetes. The corresponding values of each and the formula to make this calculation are shown in Table 9.

Table 8 Blood Sugar and Ale Targets for Diabetes

Time

ADA(mg/dl)

AACE (mg/dl)

Fasting

70-130

Less than 110

2 hours after eating

Less than 180

Less than 140

Alc

Less than 7.0% and as close to 6% as is safely achievable; less than 8% in young children, the elderly, and those at high risk of hypoglycemia

Less than 6.5%

Source: Data from ADA: American Diabetes Association; AACE: American Association of Clinical Endocrinologists.

 
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