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 data enables the person with diabetes to take a more active role in their diabetes management and care. Working with a certified diabetes care and education specialist to learn about BGM and glucose pattern management is critical at the time of diagnosis as well as whenever there is a change in medication or their condi- tion or when glycemic goals are not being met6. Evidence-Based Practice: Findings from the Diabetes Control and Complication Trial (DCCT), a prospective randomized con- trol trial (RCT) of intensive glycemic management versus standard glycemic management in patients with type 1 diabetes, showed definitively better glycemic control with a 50%-76% reduction in the development and progression of microvascular complications (e.g., retinopathy, neuropathy, and chronic kidney disease) in pa- Hemoglobin A1C The hemoglobin A1C level indicates the overall level of glucose stability or control. Glucose in the plasma is attached to the he- moglobin molecule in red blood cells by a process called glyca- tion, thus giving rise to the terms glycated and glycosylated he- moglobin. The most common type of hemoglobin found in adults
tients. In addition, the Epidemiology of Diabetes Interventions and Complications (EDIC) study followed patients from the DCCT study two decades later and found persistent microvascular ben- efits despite loss of follow-up among some patients 23 . Self-Assessment Quiz Question #2 What is the overall benefit of blood glucose monitoring (BGM)? a. Keeping a record of blood glucose control for the health care provider. b. Determining how often a patient monitors their blood glucose. c. Decreasing the need for frequent laboratory tests. d. Monitoring the effectiveness of the diabetes treatment plan. Self-Assessment Quiz Question #3 For nonpregnant adults with diabetes and without limited life expectancy, the American Diabetes Association (ADA) recom- mends that glycemic target levels for preprandial fasting blood glucose levels should be:
a. 60 to 90 mg/dL. b. 70 to 100 mg/dL. c. 80 to 130 mg/dL. d. 110 to 140 mg/dL.
is hemoglobin A. With the average life span of the red blood cell being about 120 days, A1C levels reflect weighted mean glucose from the preceding 12 weeks, with the most recent glucose lev- els having a more significant impact. Blood glucose levels from the most recent 30 days have a more substantial effect on A1C
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