Taking charge: how self-monitoring can improve diabetes management

Monitoring your blood glucose levels along with keeping a check on your blood pressure and ensuring your medication is monitored are the cornerstones of self-management when you have Type 2 diabetes.

“Comprehensive diabetic education empowers people living with diabetes to be more informed and enables them to get involved in decision making when it comes to glycaemic targets and setting specific goals,” says Dr Elana du Plessis, endocrinologist at Mediclinic Panorama.

She explains more.

Setting glycaemic goals

The primary goal of treating hyperglycaemia – or high blood glucose – is to prevent complications, Dr du Plessis says.

“This is achieved by setting a patient-specific HbA1C target based on how long the patient has had diabetes, the patient’s general health and the risk of hypoglycaemia, or low blood glucose.”

HbA1C is a blood test that measures the amount of glucose attached to the haemoglobin portion of your red blood cells and reflects the average blood glucose for a period of three months.

“For most people, the goal HbA1C is less than 7%, which equates to an average blood glucose value of 8.6mmol/L,” Dr du Plessis says. “An HbA1C test is performed every three to six months, depending on the degree of glycaemic control needed.”

How an HbA1C target differs patient by patient

The risk of diabetic complications increases with the rise in blood glucose levels. “For this reason an HbA1C of 7% or less is advocated for most diabetics, or even less than 6.5% for newly diagnosed diabetics in general good health without risking hypoglycaemia.

A target HbA1C of 7.1 to 8.5% may be acceptable for frail or elderly individuals, people with limited life expectancy, patients with significant comorbidities, including chronic renal failure or multiple co-morbidities, and diabetics experiencing recurrent severe hypoglycaemic episodes,” Dr du Plessis explains.

The importance of self-monitoring

Self-monitoring of blood glucose (SMBG) with finger-prick blood glucose metres or glucometres – a device for measuring the concentration of glucose in the blood – is encouraged for all people living with diabetes.

The frequency of self-monitoring may vary depending on the type of diabetes, diabetic-related complications and their specific treatment regime. The more intense the insulin regime, the more frequent testing is required.

“Self-monitoring data should be reviewed by both the healthcare provide and the patient at regular intervals to allow an opportunity to troubleshoot and adjust therapy based on patient-specific glucose profiles,” Dr du Plessis says.

“The recommended fasting or pre-meal SMBG is 4.0 – 7.0mmol/L and the SMBG post-meal is 5.0 – 10mmol/L to achieve an HbA1C of 7%.”

When to self-monitor

• If you’re on oral agents only
• Patients not on insulin can test their glucose three to five times a day or more. This will allow the patient and the healthcare provider to have an overview of day-to-day glycaemic variability.
• Once-daily insulin (usually a night-time injection)
• Individuals on basal insulin should test their glucose daily, preferably first thing in the morning before eating (fasting SMBG). This will allow your healthcare provider to adjust the insulin dose if your fasting target is not met.
• Using insulin two to four times a day

Once insulin requirements increase in frequency, SMBG should be performed at the time before insulin is administered at least three times a day.

When to SMBG more frequently

“More intense SMBG may be required during periods of acute illness, fasting, poor glycaemic control, frequent hypoglycaemic episodes and pregnancy,” Dr du Plessis says.