Home Blood Glucose Monitoring Why, When & How

Julie Freeland Hilary Yule

A few questions…

• Why?• When?• How?

Why?

• Type 1 Diabetes Mellitus-Strongly recommended-Improve control-Special circumstances

• Type 2 Diabetes Mellitus-Patient choice-Individual-Inform – food and exercise

-Increase motivation

Why?

• Lifestyle change• Record and understand results• To involve Diabetes Team• Patient empowerment

Why?

• HbA1c <7% delay or prevent problems with eyes, kidneys and nerves than those with HbA1c >8%

• Lower HbA1c - improvement• Reference DCCT 1993

When?

• Individual patient choice• Treatment changes• HbA1c ↑• Lifestyle change• Optimal control FOR PATIENT• Record and Understand results

When?

• HBGM (Home Blood Glucose Monitoring)• Meter • Strips• TIMING• Different times

-Pre-meals-Fasting-Before bed-2am

How?

• Using an appropriate meter suitable for individual needs.

• Diabetes Team are here to help

Special CircumstancesType 1 Diabetes Mellitus• During illness or Ketonuria• Before/After moderate Physical

Activity• Before Driving (any distance)• Psychological/Emotional Stress• Hypoglycaemia, alcohol• Pregnancy or Pre-pregnancy

planning

Special CircumstancesType 1 Diabetes Mellitus

• After a change of insulin/regimen

• DAFNE

• Change in lifestyle – job/shift work

Special CircumstancesType 2 Diabetes Mellitus

• During illness, steroids

• Before/After moderate Physical Activity

• Psychological/Emotional Stress

• Hypoglycaemia

• Pregnancy or Pre-pregnancy planning

Target?

• Individual basis• Aim 4-9 mmol/l• Discuss with the team• 17 and above check for ketones• Illness

HbA1c Average Mean plasma blood glucose(mmol/l)

12% 19.5

11% 17.5

10% 15.5

9% 13.5

8% 11.5

7% 9.5

6% 7.5

5% 5.5

Adjusting treatment

• Diabetes Team to educate and follow up on an individual basis

Ketone Testing

• Urine ketostix• Blood ketones

Thank You Any Questions?