Page 25 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)
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VOLUME 9 NUMBER 4 • NOVEMBER 2012
167
SA JOURNAL OF DIABETES & VASCULAR DISEASE
MONITORING
N •
ICE Guidelines for the Management of Type 2 Diabetes. 2008
Blood glucose self-monitoring in type 1 and type 2 diabetes: reaching a
•
multi-disciplinary
consensus.
•
Diabetes and Primary Care
2004;
6
(1):8-16.
Medicines and Healthcare products Regulatory Agency (MHRA).
•
Medical Device Alert 01/07/2008 Ref: MDA/2008/046.
MORE INFORMATION
Type of patient Frequency of testing Additional points
Type 1
At least four times a
day
Monitoring should allow
individuals to adjust treatment
correctly in line with results.
Frequent monitoring may be
necessary to avoid metabolic
emergency states. Test more
frequently during periods of
illness, when lifestyle changes,
during exercise and when driv-
ing. Test at night if unrecog-
nised hypos are suspected.
Type 2 basal
bolus regimen
At least four times
a day
These individuals should be
treated as for type 1 diabetes
patients.
Type 2 twice
a day
mixed insulin
Twice daily
Fasting blood sugar allows
titration of evening dose.
Pre-evening meal blood sugar
allows titration of morning
dose. When target levels are
reached, testing should be
spread throughout the day to
include pre- and postprandial,
fasting and before bedtime.
Testing can be on three days
out of seven, if stable.
Type 2 basal
insulin
Once daily
Fasting blood sugar allows
titration of evening dose. Once
stable, can reduce to random
times to allow identification of
pre-meal hypos or post-meal
highs.
Pregnant type 1
or type 2
At least four times a
day
These women need even
more intensive monitoring
and will require many test
strips during the first trimester
when hypo risk is greater.
Testing at all times of the day
is important.
couraged from building up stocks of test strips. This can happen when
they request a repeat prescription for test strips at the same time as
other medications, as this means some will go out of date.
QUALITY CONTROL
All meters need regular quality control to ensure accurate results. This
needs to be part of initial patient education. Quality control should be
repeated with each change of test strips.
Solutions for quality control testing are unique to each meter and are
available from manufacturers. Each bottle of control solution has a shelf
life after which it expires. However, once opened it must be discarded
within a shorter period of time, which is usually three months after open-
ing although this varies with each manufacturer. People should be en-
couraged to write the date of opening on the bottle.
More frequent quality control is needed in the clinic, with daily checks
if the meter is used daily, weekly for less frequent use and monthly if
testing is performed less often. The results must be recorded, signed for
and kept for five years, by law.
The gold standard is to be part of an external quality control system.
This uses “blind” solutions and results are compared against other me-
ters. These are often run by hospitals or primary care trusts. All profes-
sional users should have certificated training in the use of their meter,
which manufacturers will often provide.
WHEN TO MONITOR BLOOD GLUCOSE LEVELS
The frequency of blood glucose monitoring depends on the individual
and what is to be achieved from the recordings. There will usually be
a period of intensive monitoring during initiation and titration of insulin,
which gradually reduces in frequency as control stabilises and familiarity
develops.
CONCLUSION
Self-monitoring of blood glucose is a vital part of the management of
people with diabetes who are on insulin. Education is important, both
at insulin initiation and throughout the rest of the individual’s life to
provide people with the ability and confidence to titrate their own in-
sulin according to blood results to achieve excellent glycaemic control
and associated health benefits. Health professionals have a key role in
ensuring test results are accurate, recognised and followed up, that
professional standards and legal requirements are met and that the
ongoing management of people using insulin is based on successful
partnership.
