Table 3. Blood Glucose Monitoring (BGM) Frequency Recommendations Patient Profiles (Medication Regimens) Recommendations Adult patients with type 1 diabetes (Intensive insulin regimen)
4 to 10 times/day. An intensive insulin regimen involves multiple insulin injections/day or insulin pump therapy. Consider monitoring before meals and snacks, occasionally post- prandially, at bedtime, before exercise, when hypoglycemia is suspected, after treating hypoglycemia, and when undertaking hazardous tasks like driving. BGM recommended. Evidence is insufficient regarding when and how often to perform BGM. Patients taking basal insulin may benefit from checking their fasting blood glucose daily, as it provides data enabling providers to appropriately adjust the dose of basal insu- lin. Additional testing before exercise or critical tasks is important if there is a tendency for hypoglycemia. If hypoglycemia occurs, testing should be done until the patients is normo- glycemic. Testing when symptoms of hyperglycemia develop, or acute illness occurs will provide data helpful to determine a need for change in insulin or other medication dose. BGM recommended . Although there isn’t sufficient evidence that regular BGM in patients not on insulin therapy improves A1C, doing so may help patients identify the impact of dietary choices and activity level on blood glucose levels. Consider at the time of diagno- sis and when helping with problem solving as part of ongoing diabetes self-management education (DSME).
Adult patients with type 2 diabetes (Taking basal insulin with or without anti- hyperglycemic agents)
Adult patients with type 2 diabetes (On noninsulin therapy)
Adapted from American Diabetes Association4. While there are recommendations regarding the frequency of testing, the frequency of BGM depends on the type of diabetes, the complexity of treatment, and individual characteristics along with how the data will be used. For example, the patient with well- controlled type 2 diabetes using meal planning and exercise may only need to monitor fasting levels daily or several times per week. The patient with type 2 taking oral medication may be asked to monitor fasting and postprandial levels. The patient using flexible insulin dosing and carbohydrate counting is likely to test before each meal, at bedtime, and periodically after meals. Patients are also encouraged to test more often when any changes to their treatment regimens occur. For example, the patient moving from oral agents to insulin or the patient moving from two to three daily Continuous glucose monitoring Blood glucose levels fluctuate widely throughout the day and are influenced by a multiple of internal and external factors. Intermit - tent glucose testing regimens may not reflect these fluctuations and increased testing may be inconvenient or unachievable for a given patient. BGM is paramount in achieving optimal glycemic targets but only to the extent that the readings are accurate and timely. In the early 2000s, real-time continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitor- The technology of a CGM A CGM device is a wearable body sensor that automatically and repeatedly measures blood glucose levels 24 hours a day (every 5 to 15 minutes). Parts of a CGM device include a wearable sensor, a transmitter that wirelessly sends readings, and a receiver that displays the readings to the user. Figure 4 displays the various parts of a CGM. A CGM provides an accurate picture of blood glucose levels, allowing the patient to assess glycemic patterns quickly.
injections will benefit from testing four times a day. Regardless of testing frequency, the most critical issue is whether the patient knows what to do with the information obtained with BGM 8,9 . Diabetes educators and other healthcare professionals often use BGM results to demonstrate the impact of exercise, medications, and specific foods on blood glucose levels. It is also common for a patient to have elevated blood glucose values during periods of physiologic stress, such as during acute illness. For this reason, all patients are advised to monitor more often on sick days. Capillary blood glucose levels for hospitalized patients with diabetes should be performed four times daily. ing became available and recommended by the ADA and AACE for all persons with diabetes, especially those on intensive insulin therapy. Study findings have demonstrated that use of CGM has significantly reduced hypoglycemia compared to BGM alone in patients with type 1 diabetes 10 . In addition, significant reduc - tions have been shown in A1C among children, adults, and older adults 11,12 using CGM.
Figure 4. CGM Device
From Popov, A. Woman holding smartphone in hand with bad level of blood sugar on the screen. (https://www.dreamstime.com/woman- hold- ing-smartphone-hand-bad-level-blood-sugar-screen-woman-checking- blood-sugar-level-smart-phone-image182255889). Copyright © 2000-2022 Dreamstime. All rights reserved.
Page 70
Book Code: RPUS3024
EliteLearning.com/Pharmacy
Powered by FlippingBook