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Please note than while this post has a lot of good basic information, as it is an older post, much of the information is now out of date, please check up to date information if you wish to read this.
( My thanks to Zoroaster for bringing this post to our attention )
Sugarless Sue.
Forum Monitor.
What is Self Monitoring of Blood Glucose?
Self Monitoring of Blood Glucose (SMBG) is a vital tool which those of us living with diabetes can use to improve our blood glucose management. It involves a blood glucose meter, a test strip, and a drop of blood (usually from a finger but can also be from alternate sites).
What does it tell me?
Simply put SMBG will identify if you are wikipedia.org/wiki/Hyperglycemia]hyperglycaemic (high BG) or wikipedia.org/wiki/Hypoglycemia]hypoglycaemic (low BG). Readings can be either in mg/dl (milligrams per decilitre) or mmol/L (millimoles per litre) (for those with an interest in this kind of thing, faqs.org/faqs/diabetes/faq/part1/section-9.html this document is a good starting point). European meters must provide a reading in mmol/L. In this document all values will be given in mmol/L.
Meters will take a whole blood sample and report it as-is or convert it to a plasma BG reading. Plasma BG readings are higher than whole BG readings by between 12% and 15%. It is important when comparing readings that you compare alike readings, so as a rule of thumb multiply a whole BG by 1.12 to arrive at an approximate plasma BG equivalent, or divide a plasma BG reading by 1.12 to arrive at an approximate whole BG reading.
A good way of testing whether your meter is accurate is to test a healthy non diabetic person and see if they have apparently normal blood glucose levels. Blood glucose concentrations fluctuate throughout the day. Typically levels rise after a meal and fall during fasting. Fasting blood glucose levels are relatively constant in individuals. A level of less than 6 mmol/l is considered to be normal.
Another way of testing the accuracy of your meter is to request a control solution from your meter manufacturer.
What should my readings be?
Diabetes UK have published NHS recommendations diabetes.org.uk/Guide-to-diabetes/Treatment__your_health/Monitoring/Blood_glucose/Blood-glucose-target-ranges/ here, in brief:
3.5 - 5.5mmols/l before meals
less than 8mmols/l, 2 hours after meals. (No longer correct)
The following information can be found on dsolve.comdsolve:
dsolve.comdsolve also contains good information about personal targets and how to set about achieving those on dsolve.com/news-aamp-info-othermenu-60/27-how-tos/88-meter this page.
Opinion varies about what the ideal range is, each of us should determine, with our care teams where appropriate, what is acceptable to us.
Should I test?
Absolutely, without a doubt - with one caveat - if you want to. You may also need to, under law, dependent on your driving status and medication regime.
There is no doubt that achieving normal blood sugars most of the time requires a lot of personal education, self experimentation, time and effort. Whether this is worth it or not is a decision that you must make.
Firstly, let's examine nice.org.uk/nicemedia/pdf/CG66diabetesfullguideline.pdf NICE guidelines which clearly state
There is a catch-all phrase in recommendation 23, to assess changes in glucose control resulting from medications and lifestyle changes, odds on, if you have been newly diagnosed with type 2 diabetes then you are going to be making some serious lifestyle changes.
At the time of posting it is believed that both Wales and Northern Ireland follow NICE guidelines.
Appropriately for a National Health Service, Scotland has separate guidelines, in 2001 SIGN issued the sign.ac.uk/pdf/sign55.pdf]following guidelines
And in 2005 SIGN reported that:
In 2005 Sue Roberts, then National Clinical Director for Diabetes, produced a factsheet for SHAs on SMBG, the fact sheet reiterates NICE guidance.
PCTs have chosen to interpret that advice and, as I understand it, a description of that interpretation can be found on page 16 of dmforum.org.uk/DMF/PDF/SueCradock.pdf]this document. One of the conditions under which it is recommended that type 2s perform a test is if we "have high blood glucose after eating". A bit cart before the horse, but the only sure way we can find out if we have high BG after eating is by testing.
When should I test?
First thing in the morning, before eating, one hour after eating, two hours after eating, and before bed is the gold standard. It is a question of cost, although it shouldn't be. It is very much down to you and your care team to negotiate test frequency.
alt-support-diabetes.org]alt.support-diabetes.org has alt-support-diabetes.org/NewlyDiagnosed.htm this handy page which discusses SMBG in some detail. Phlaunt have produced a phlaunt.com/diabetes/22229807.php handy flyer which summarises the advice given on alt-support-diabetes.org.alt.support-diabetes.org.
How should I interpret the results?
There is a very strong link between what you eat and the resulting blood glucose levels. SMBG can help you identify what additional dietary changes you should make over and above the recommendations from your GP, DN, or Dietitian. SMBG can suggest reducing portion sizes or cutting out a specific food all together. SMBG can help you identify the impact of exercise on your blood glucose levels
The one hour test will, on a level playing field, indicate the highest peak of BG after a meal.
The two hour test will show what's happening after the digestive system has done its work on your last meal.
Be aware of the pizza-effect. This is where fatty foods take longer to digest than non-fatty foods.
dsolve.comdsolve has this to say about interpreting results:
My GP won't prescribe test strips
Unfortunately the NHS and many other international health care systems do not currently provide an available, affordable and appropriate educational package to help you achieve normal blood sugars. Helping you get the degree of control you want is the purpose of this post. It is essential that you become an expert in your own type of diabetes and its management.
The first thing you must do is quote NICE guidelines and ask them to provide you with self-management education so that you can learn how to use SMBG effectively.
If they still refuse, ask them why they are refusing.
* If the directive has come from the PCT then make them aware of this statement from Ann Keen, Under-Secretary of State for Health in a written response to Michael Foster MP
* If the GP asserts that testing causes anxiety and depression, suggest that the evidence used to support that little nugget came from a group of newly diagnosed type 2s and its no wonder they were anxious and/or depressed.
* If the GP asserts that there is no evidence to suggest SMBG helps reduce BG, tell them that that is a "no sh*t sherlock" statement and that you agree SMBG on its own will not improve BG management and that there are associated lifestyle changes that can be made from interpreting the results of SMBG
Diabetes UK's position statement on SMBG can be found diabetes.org.uk/templates/GenericContent.aspx?id=4442 here.
My GP will prescribe test strips
Good for you. Shout about it. Let other, less fortunate, type 2s in your area know that you have one of the good guys.
Thanks to Sugarless Sue, Katharine, CatherineCherub, and Trinkwasser for their input to this post.
( My thanks to Zoroaster for bringing this post to our attention )
Sugarless Sue.
Forum Monitor.
What is Self Monitoring of Blood Glucose?
Self Monitoring of Blood Glucose (SMBG) is a vital tool which those of us living with diabetes can use to improve our blood glucose management. It involves a blood glucose meter, a test strip, and a drop of blood (usually from a finger but can also be from alternate sites).
What does it tell me?
Simply put SMBG will identify if you are wikipedia.org/wiki/Hyperglycemia]hyperglycaemic (high BG) or wikipedia.org/wiki/Hypoglycemia]hypoglycaemic (low BG). Readings can be either in mg/dl (milligrams per decilitre) or mmol/L (millimoles per litre) (for those with an interest in this kind of thing, faqs.org/faqs/diabetes/faq/part1/section-9.html this document is a good starting point). European meters must provide a reading in mmol/L. In this document all values will be given in mmol/L.
Meters will take a whole blood sample and report it as-is or convert it to a plasma BG reading. Plasma BG readings are higher than whole BG readings by between 12% and 15%. It is important when comparing readings that you compare alike readings, so as a rule of thumb multiply a whole BG by 1.12 to arrive at an approximate plasma BG equivalent, or divide a plasma BG reading by 1.12 to arrive at an approximate whole BG reading.
A good way of testing whether your meter is accurate is to test a healthy non diabetic person and see if they have apparently normal blood glucose levels. Blood glucose concentrations fluctuate throughout the day. Typically levels rise after a meal and fall during fasting. Fasting blood glucose levels are relatively constant in individuals. A level of less than 6 mmol/l is considered to be normal.
Another way of testing the accuracy of your meter is to request a control solution from your meter manufacturer.
What should my readings be?
Diabetes UK have published NHS recommendations diabetes.org.uk/Guide-to-diabetes/Treatment__your_health/Monitoring/Blood_glucose/Blood-glucose-target-ranges/ here, in brief:
3.5 - 5.5mmols/l before meals
less than 8mmols/l, 2 hours after meals. (No longer correct)
The following information can be found on dsolve.comdsolve:
dsolve said:Normal blood sugars for fit young non diabetics are 4.6 on waking and prior to meals and bedtime provided no snacks have been eaten. Two hours after a meal such a person’s blood sugar will be down to five or six. Blood sugars should not normally go below 3.3 even if a person has not eaten or has been exercising. A healthy young person can expect to have a hbaic of less than 5.6% although the range given in laboratories takes the not so fit into consideration and often gives an upper limit of normal as 6.0%
What we are trying to achieve with type one and type two diabetes is a replication of normal blood sugar patterns as much of the time as is achievable and desirable for you.
dsolve.comdsolve also contains good information about personal targets and how to set about achieving those on dsolve.com/news-aamp-info-othermenu-60/27-how-tos/88-meter this page.
Opinion varies about what the ideal range is, each of us should determine, with our care teams where appropriate, what is acceptable to us.
Should I test?
Absolutely, without a doubt - with one caveat - if you want to. You may also need to, under law, dependent on your driving status and medication regime.
There is no doubt that achieving normal blood sugars most of the time requires a lot of personal education, self experimentation, time and effort. Whether this is worth it or not is a decision that you must make.
Firstly, let's examine nice.org.uk/nicemedia/pdf/CG66diabetesfullguideline.pdf NICE guidelines which clearly state
NICE Guidelines said:Offer self-monitoring of plasma glucose to a person newly diagnosed with Type 2 diabetes only as an integral part of his or her self-management education. Discuss its purpose and agree how it should be interpreted and acted upon.
R23 Self-monitoring of plasma glucose should be available:
to those on insulin treatment
to those on oral glucose lowering medications to provide information on hypoglycaemia
to assess changes in glucose control resulting from medications and lifestyle changes
to monitor changes during intercurrent illness
to ensure safety during activities, including driving.
R24 Assess at least annually and in a structured way:
self-monitoring skills
the quality and appropriate frequency of testing
the use made of the results obtained
the impact on quality of life
the continued benefit
the equipment used.
R25 If self-monitoring is appropriate but blood glucose monitoring is unacceptable to the individual, discuss the use of urine glucose monitoring.
There is a catch-all phrase in recommendation 23, to assess changes in glucose control resulting from medications and lifestyle changes, odds on, if you have been newly diagnosed with type 2 diabetes then you are going to be making some serious lifestyle changes.
At the time of posting it is believed that both Wales and Northern Ireland follow NICE guidelines.
Appropriately for a National Health Service, Scotland has separate guidelines, in 2001 SIGN issued the sign.ac.uk/pdf/sign55.pdf]following guidelines
SIGN Guidelines said:The literature in this area is difficult to assess. Many of the studies cannot be compared as the patient groups were different and glucose monitoring was usually just one part of a multifactorial intervention programme.57 However, a comprehensive package of care which includes glucose self-monitoring is usually effective in improving glycaemic control in type 1 diabetes.
No studies have adequately assessed the benefits of glucose monitoring on glycaemic control, or the relative benefits of blood glucose monitoring vs. urine testing. In general, urine testing is less costly than blood testing, however the preferred method of glucose monitoring varies according to type of diabetes. Some patients with type 2 diabetes prefer urine testing while patients with type 1 diabetes appear to favour blood testing.
And in 2005 SIGN reported that:
SIGN said:Self-monitoring of blood glucose may be effective in improving glycaemic control in patients with type 2 diabetes who are not using insulin.
In 2005 Sue Roberts, then National Clinical Director for Diabetes, produced a factsheet for SHAs on SMBG, the fact sheet reiterates NICE guidance.
PCTs have chosen to interpret that advice and, as I understand it, a description of that interpretation can be found on page 16 of dmforum.org.uk/DMF/PDF/SueCradock.pdf]this document. One of the conditions under which it is recommended that type 2s perform a test is if we "have high blood glucose after eating". A bit cart before the horse, but the only sure way we can find out if we have high BG after eating is by testing.
When should I test?
First thing in the morning, before eating, one hour after eating, two hours after eating, and before bed is the gold standard. It is a question of cost, although it shouldn't be. It is very much down to you and your care team to negotiate test frequency.
alt-support-diabetes.org]alt.support-diabetes.org has alt-support-diabetes.org/NewlyDiagnosed.htm this handy page which discusses SMBG in some detail. Phlaunt have produced a phlaunt.com/diabetes/22229807.php handy flyer which summarises the advice given on alt-support-diabetes.org.alt.support-diabetes.org.
How should I interpret the results?
There is a very strong link between what you eat and the resulting blood glucose levels. SMBG can help you identify what additional dietary changes you should make over and above the recommendations from your GP, DN, or Dietitian. SMBG can suggest reducing portion sizes or cutting out a specific food all together. SMBG can help you identify the impact of exercise on your blood glucose levels
The one hour test will, on a level playing field, indicate the highest peak of BG after a meal.
The two hour test will show what's happening after the digestive system has done its work on your last meal.
Be aware of the pizza-effect. This is where fatty foods take longer to digest than non-fatty foods.
dsolve.comdsolve has this to say about interpreting results:
dsolve said:"Eat to meter" is a shortened way to say that you eat to ensure that YOUR BLOOD SUGARS STAY WITHIN YOUR TARGET RANGE.
Unfortunately many diabetologists genuinely believe that diabetics cannot realistically achieve normal blood sugars. They hope that the best they can do is to monitor the inevitable decline in health that high blood sugars produce long term and sort out the worst of the complications with drugs, lasers and surgery.
My GP won't prescribe test strips
Unfortunately the NHS and many other international health care systems do not currently provide an available, affordable and appropriate educational package to help you achieve normal blood sugars. Helping you get the degree of control you want is the purpose of this post. It is essential that you become an expert in your own type of diabetes and its management.
The first thing you must do is quote NICE guidelines and ask them to provide you with self-management education so that you can learn how to use SMBG effectively.
If they still refuse, ask them why they are refusing.
* If the directive has come from the PCT then make them aware of this statement from Ann Keen, Under-Secretary of State for Health in a written response to Michael Foster MP
Ann Keen said:Any PCT which is automatically discouraging the prescription of blood glucose testing strips is not acting in according with NICE's advice that self-monitoring may prove useful to people in their overall approach to self-care.
* If the GP asserts that testing causes anxiety and depression, suggest that the evidence used to support that little nugget came from a group of newly diagnosed type 2s and its no wonder they were anxious and/or depressed.
* If the GP asserts that there is no evidence to suggest SMBG helps reduce BG, tell them that that is a "no sh*t sherlock" statement and that you agree SMBG on its own will not improve BG management and that there are associated lifestyle changes that can be made from interpreting the results of SMBG
Diabetes UK's position statement on SMBG can be found diabetes.org.uk/templates/GenericContent.aspx?id=4442 here.
My GP will prescribe test strips
Good for you. Shout about it. Let other, less fortunate, type 2s in your area know that you have one of the good guys.
Thanks to Sugarless Sue, Katharine, CatherineCherub, and Trinkwasser for their input to this post.