Self-monitoring of blood glucose to

achieve a good HbA1cRichard Croft

Diabetes Lead Berkshire West

The impact of a 1% reduction in HbA1c

Correlation with complications

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0 5 10 15 20 25 30 35

HbA

1c (D

CC

T %

)

No. Pots of strips used

Scatter graph to show correlation of HbA1c and number glucometer strips used

HbA1c DCCT (TR 6.5 - 7.5%)

Audit of correlation between number of pots of strips used and HbA1c amongst diabetics at Tilehurst

((There is no correlation at all!)

Think: why is he testing?What will he do with the result?

What will YOU do with the result?

Diabetics who use insulin – Type 1, and Type 2 who use insulin

Women with gestational diabetes Some patients who use sulphonylureas

(eg gliclazide), especially if they drive Other patients with intercurrent illness

Who should use them?

Everybody else!!

And who should not use them (usually)?

• To detect hypo- and hyper-glycaemia in diabetics who use insulin (and SUs)

• To help patients prevent immediate serious illness (hypoglycaemic attacks and DKA)

• As part of the long-term management of diabetes to maintain good control and prevent micro- and macro-vascular complications

Why test at all?

In Type 1 DM◦ Before meals 4-7mmol/l◦ 2hrs after meals < 9mmol/l

In Type 2 DM◦ Before meals 4-7mmol/l◦ 2 hrs after meals < 8.5mmol/l

Targets for SMBG

• Twice daily insulin therapy– Test 2-3x day, varying testing times between

fasting, premeal and postmeal to identify trends

• Intensive insulin therapy (basal bolus)– Monitor 2-4x day normally– Monitor at least 4x day if they alter doses at

mealtimes• More frequent testing during

intercurrent illness

Monitoring in Type 1 DM

• Twice daily insulin regime– Test 1-2x day varying times between fasting,

premeal and postmeal• Intensive insulin therapy (basal bolus)

– Monitor 2-4x day normally– Monitor at least 4x day if they alter doses at

mealtimes• Once daily insulin (basal regime)

– Test fasting BG once daily during initiation, can then be reduced to 1-2x week)

Monitoring in Type 2 diabetics who use insulin

Naseem is going to talk some more about testing in Type 1 diabetes

We are going to introduce carbohydrate counting as a means of improving control in people with Type 1, and a very smart device to help patients calculate their correct dose of insulin

How can we do better?