When to Monitor Your Blood Glucose

[Guest guest]

I read this piece and thought it quite interesting. So many people ask

when to test and this lays it out very well.

Barb in NH

The URL for the piece is:

www.postgradmedicine.com/issues/2005/11-05/cc_nov.htm

http://www.postgradmedicine.com/issues/2005/11-05/cc_nov.htm>

When to monitor fingerstick blood glucose?

VOL 118 / NO 5 / NOVEMBER 2005 / POSTGRADUATE MEDICINE

Q: When should fingerstick blood glucose level be monitored in a

diabetic patient who is taking insulin? Should it be measured first

thing in the morning and then 2 hours after each meal? Or should it

be measured first thing in the morning and then before meals? How

does this recommendation change if a patient is taking only an oral

hypoglycemic agent?

A: Several recent studies have shown that improved blood glucose

control leads to fewer complications, regardless of the type of

diabetes. For the physician, the " gold standard " in assessing

diabetes control is the hemoglobin A1c level. The patient, however,

relies on fingerstick readings to help decide how to manage blood

glucose each day. Improvements in day-to-day fingerstick readings

should translate to an improved hemoglobin A1c level and fewer

diabetic complications.

Recent epidemiologic data suggest that postprandial hyperglycemia is

key to the development of macrovascular disease. Indeed, some

studies suggest that postprandial blood glucose level is a better

predictor of macrovascular disease than hemoglobin A1c level (1).

Moreover, mounting evidence suggests that control of postprandial

blood glucose excursions may be an important goal in preventing

diabetic complications.

Until recently, management of postprandial hyperglycemia was

problematic because of the pharmacokinetic limitations of insulin

and oral antidiabetic agents. With insulin analogues and newer, fast-

acting oral agents, management of postprandial hyperglycemia is much

simpler.

The desired end point is extremely tight glucose control in young

patients, pregnant women, and patients with comorbid problems that

demand tighter control. In such patients, improved control of

postprandial glycemic excursions is achievable with a basal and

bolus program involving rapid-acting and long-acting insulin

analogues in patients taking insulin and with fast-acting oral

agents in patients receiving oral therapy. With the newer agents,

hypoglycemia is not the issue it once was. To achieve very tight

postprandial glucose control, patients must be motivated and

educated. In patients who are unwilling or unable to adjust to

intensified forms of diabetes management, it is probably more

prudent to strive for improvement in preprandial blood glucose

levels, because achieving this goal is generally less complicated.

Whitaker, MD, FRCPC

Consultant, Section of Endocrinology

Mayo Clinic sdale, sdale, Arizona

[Guest guest]

Well...it's fine as far as it goes. But why limit " extremely tight

control " to

" ...young patients, pregnant women, and patients with comorbid problems

that demand tighter control. " ?

This should be the goal of ALL diabetics.

Geez!

Vicki, who isn't young or pregnant, has no comorbid problems and Never

Ever Wants Any!

When to Monitor Your Blood Glucose

>I read this piece and thought it quite interesting. So many people ask

> when to test and this lays it out very well.

>

> Barb in NH

>

> The URL for the piece is:

> www.postgradmedicine.com/issues/2005/11-05/cc_nov.htm

> http://www.postgradmedicine.com/issues/2005/11-05/cc_nov.htm>

>

>

>

> When to monitor fingerstick blood glucose?

> VOL 118 / NO 5 / NOVEMBER 2005 / POSTGRADUATE MEDICINE

>

> Q: When should fingerstick blood glucose level be monitored in a

> diabetic patient who is taking insulin? Should it be measured first

> thing in the morning and then 2 hours after each meal? Or should it

> be measured first thing in the morning and then before meals? How

> does this recommendation change if a patient is taking only an oral

> hypoglycemic agent?

>

> A: Several recent studies have shown that improved blood glucose

> control leads to fewer complications, regardless of the type of

> diabetes. For the physician, the " gold standard " in assessing

> diabetes control is the hemoglobin A1c level. The patient, however,

> relies on fingerstick readings to help decide how to manage blood

> glucose each day. Improvements in day-to-day fingerstick readings

> should translate to an improved hemoglobin A1c level and fewer

> diabetic complications.

>

> Recent epidemiologic data suggest that postprandial hyperglycemia

> is

> key to the development of macrovascular disease. Indeed, some

> studies suggest that postprandial blood glucose level is a better

> predictor of macrovascular disease than hemoglobin A1c level (1).

> Moreover, mounting evidence suggests that control of postprandial

> blood glucose excursions may be an important goal in preventing

> diabetic complications.

>

> Until recently, management of postprandial hyperglycemia was

> problematic because of the pharmacokinetic limitations of insulin

> and oral antidiabetic agents. With insulin analogues and newer,

> fast-

> acting oral agents, management of postprandial hyperglycemia is

> much

> simpler.

>

> The desired end point is extremely tight glucose control in young

> patients, pregnant women, and patients with comorbid problems that

> demand tighter control. In such patients, improved control of

> postprandial glycemic excursions is achievable with a basal and

> bolus program involving rapid-acting and long-acting insulin

> analogues in patients taking insulin and with fast-acting oral

> agents in patients receiving oral therapy. With the newer agents,

> hypoglycemia is not the issue it once was. To achieve very tight

> postprandial glucose control, patients must be motivated and

> educated. In patients who are unwilling or unable to adjust to

> intensified forms of diabetes management, it is probably more

> prudent to strive for improvement in preprandial blood glucose

> levels, because achieving this goal is generally less complicated.

>

> Whitaker, MD, FRCPC

> Consultant, Section of Endocrinology

> Mayo Clinic sdale, sdale, Arizona

>