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How and When to Measure Blood Sugar Part 1 of 2Articles - Dr. Bernstein Shares His Insights The nondiabetic body is constantly measuring its levels of blood sugar and compensating for values that are either too high or too low. A diabetic’s body has lost much or all of this capability. With a little help from technology, you can take over where your body has left off and do what it once did automatically normalize your blood sugars.Chapter 4
How and When to Measure Blood Sugar YOUR BLOOD GLUCOSE PROFILE No matter how mild your diabetes may be, it is very unlikely that any physician can tell you how to normalize your blood sugars throughout the day without knowing what your blood glucose values are around the clock. Don’t believe anyone who tells you otherwise. The only way to know what your around the clock levels are is to monitor them yourself. A table of blood sugar levels, with associated events (meals, exercise, and so on), measured at least 4 times daily over a number of days, is the key element in what is called a blood glucose profile. This pro-file, described in detail in the next chapter, gives you and your physician or diabetes educator a glimpse of how your medication, lifestyle, and diet converge, and how they affect your blood sugars. Without this information, it’s impossible to come up with a treatment plan that will normalize blood sugars. Except in emergencies, I try not to treat someone’s diabetes until I receive a blood glucose profile that covers at least one week. Blood glucose data, together with information about meals, medication, exercise, and any other pertinent data that affect blood sugar, is best recorded on the Glucograf II data sheet, illustrated on page 82. How Frequently Are Glucose Profiles Necessary? If your treatment includes insulin injections before each meal, your diabetes is probably severe enough to render it impossible for your body to automatically correct small deviations from a target blood glucose range. To achieve blood sugar normalization, it therefore may be necessary for you to record blood glucose profiles every day for the rest of your life, so that you can fine tune any out of range values. If you are not treated with insulin, or if you have a very mild form of insulin treated diabetes, it may only be necessary to prepare blood glucose profiles when needed for readjustment of your diet or medication. Typically, this might be for one to two weeks prior to every routine follow up visit to your physician, and for a few weeks while your treatment plan is being fine tuned for the first time. After all, your physician or diabetes educator cannot tell if a new regimen is working properly without seeing your blood glucose profiles. It is wise, however, that you also do a blood glucose profile for 1 day at least every other week, so you will be assured that things are continuing as planned. Selecting a Blood Glucose Measuring Outfit The measuring system usually consists of a pocket-sized electronic meter with a liquid crystal display. The outfit will include a spring driven finger sticking device and a supply of lancets. The meter is designed for use with disposable plastic strips, onto or into which a drop of blood is placed. Some brands of strips change color when exposed to glucose, and the accompanying meter measures color change. Other strips contain electrodes that conduct or generate more or less current depending upon the amount of glucose in the blood. About twenty different blood glucose metering outfits are presently being marketed in the United States. Only one or two of these currently have a degree of accuracy acceptable for our purposes. Some systems routinely report blood glucose values that are 40–100 percent in error. This can be very dangerous to the user. How these have secured approval from the Food and Drug Administration (FDA) is a matter of conjecture. Usually the problem involves poor quality control or poor design of the plastic strips, or inability to calibrate the meter accurately for different batches of strips. Although your supplier should be in a position to advise you properly on the selection of systems for blood glucose monitoring, this is almost never the case. Even physicians and educators specializing in diabetes rarely conduct the studies necessary to evaluate these products. Reports in medical journals that purport to be evaluating different blood glucose self measurement systems are frequently financed by one of the manufacturers and often present grossly deceptive conclusions. All this puts you, the consumer, in a difficult position. Designs advance so rapidly that it’s impossible to predict what will be available when you read this book. I frequently compare new meters for accuracy versus a major clinical lab. I also check the reproducibility of results. You can call our Diabetes Center at (914) 698-7525 Monday through Thursday between 9:30 a.m. and 3:30 p.m. Eastern time (U.S.A.) to find out what system we currently recommend for our patients. Accuracy is the most important feature to keep in mind when selecting a meter, so do not be seduced by low cost, size, appearance, or special features, such as built in memory, built in lancet, or built in insulin injector. Buy from a dealer who will refund your money if the system is inaccurate. You can get a rough idea of the precision or reproducibility of results of the system by performing four blood glucose measurements in succession at the dealer’s store. They should be within 5 percent of one another when blood sugars are in the 70–120 mg/dl range. Ask your physician about the systems he has evaluated. He can secure virtually any system from its manufacturer for study at no cost. A number of my patients have been tempted by advertising for blood sugar meters that contain a built-in device to puncture the skin at sites other than the fingertips (arms, buttocks, abdomen), where the puncture causes absolutely no pain. I have tested several of these products and found their blood sugar readings to be inaccurate. Far superior to these is the Bayer Vaculance for painless punctures of these alternate sites. I use it myself and a separate, very accurate meter. If blood sugar is changing rapidly, these alternate test site results may lag behind fingertip tests by as much as 20 minutes. ---------------------------------------------------------------------------------------------
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