Table 4. Glycemic Targets for Nonpregnant Adults with Diabetes and without Limited Life Expectancy American Diabetes Association (ADA)
American Association of Clinical Endocrinologists (AACE)
Fasting and preprandial blood glucose (mg/dL)
80–130
<110
Postprandial blood glucose (mg/dL)
<180; 2 hours after start of a meal
<140; 2 hours after the start of a meal
A1C (%)
<7.0 without hypoglycemia
<6.5
Adapted from American Diabetes Association 3 . Adapted from Comparison of the diabetes guidelines from the ADA/EASD and the AACE/ACE 21 . Structured BGM with a glucometer
Knowing your actual blood glucose can be a powerful motivator to improve glycemic management. When a patient sees that their blood glucose level is above or below target, this may impact their selection of food intake and activity level as well as use of or dose of medication. The data from BGM enables patients to make decisions based on current glycemic management. Using a structured approach to BGM (checking blood glucose lev- els at the same time every day) has effectively reduced A1C levels among patients performing BGM compared to those who do not perform BGM22. Structured BGM allows visualization of glycemic levels by allowing patients to record the results on a log or view on a graph that some glucometers now provide on their screen. The visualization of glycemic levels facilitates understanding of the impact of diet choices, activity level, and medication use on blood glucose levels. An example of structured
testing for BGM for patients with type 1 and type 2 diabetes is displayed in Figure 8. Structured testing for BGM in patients with intensive insulin regimens requires patients to test a minimum of seven times/day for 3 to 4 days. Structured testing involves check- ing before and 2 hours after each meal and at bedtime. Consider a case in which BGM for a person with type 1 diabetes reveals episodes of hypoglycemia before breakfast on Saturday and Sunday. Perhaps considering reducing their premeal insulin dose before breakfast is a consideration. In addition, if all post- dinner blood glucose values are above the target range of 180 mg/dL, an addition of medication may assist with glycemic man- agement. Collecting data for 3 to 4 days provides an overview of blood glucose values and patterns. Next, consider a case in which BGM for a person with type 2 dia- betes reveals prebreakfast, pre-lunch, and predinner data within target ranges. However, post-meal values are above target rang- es. These data suggest the person with diabetes needs more medication to manage their post– blood glucose excursions.
Figure 8. Structured Blood Glucose Monitoring Testing for Persons With Type 1 Diabetes Breakfast Lunch
Dinner
Bedtime
BB
AB
BL
AL
BD
AD
BT
Monday Tuesday
80
136 142 138 122 116 132 122
122 132 130 126 118 132 130
244 192 264 252 258 196 272
106 110
Wednesday
Thursday
92 74 70 68
Friday
Saturday Sunday
Structured Blood Glucose Monitoring Testing for Persons With Type 2 Diabetes Breakfast Lunch
Dinner
Bedtime
BB
AB
BL
AL
BD
AD
BT
Monday Tuesday
210
130
Wednesday
236
Thursday
142
Friday
263
Saturday
128
Sunday Note: BB: before breakfast; AB: after breakfast; BL: before lunch; AL: after lunch; BD: before dinner; AD: after dinner; BT: bedtime Note: All blood glucose values in the figure are mg/dL
There are many reasons for checking pre- and postprandial blood glucose levels. Knowing the premeal blood glucose may lead a patient to modify their food intake (especially if it is elevated be- fore the meal) and to take a specific dose of insulin. Comparing the premeal blood glucose to a 2-hour postprandial blood glu- cose helps one to discern the impact of the food eaten on the
blood glucose level. If using insulin, comparison of the pre- and post–blood glucose helps determine the appropriateness of the insulin dose. It is important for people with diabetes to learn how to interpret and evaluate blood glucose values to best adjust food intake, physical activity, and medications. Understanding blood glucose
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