Experience has shown that frequent monitoring augments patients' ability to meet their treatment goals and provides the needed feedback to pursue self-management. Still, the times and frequency of testing vary widely among individual patients, depending on their treatment goals, treatment regimen and its complexity, motivation, variability of dietary and exercise habits, physical and cognitive abilities, financial constraints, and concerns for hypoglycemia, ft is generally recommended that patients test often enough to be familiar with their usual glycemia pattern, including testing under various dietary, work, and exercise conditions. The most common practice is testing before meals and at bedtime, and occasionally between 1 and 3 a.m. Also, 2-hour post-meal testing is being increasingly recommended to ascertain postprandial glucose control, especially in patients taking rapid-acting insulin analogs or oral agents such as Repaglinide and Nateg-linide. All patients should have testing equipment and supplies on hand, and know how to use them, even if used only for emergent situations.
Common Testing Patterns
• Stable-diet-controlled—test pre-breakfast and 2 hours post-breakfast or dinner two or three times per week.
• Oral agents alone or insulin/orals combination therapy—pre-breakfast four to seven times per week, pre-lunch two or three times per week, 2 hours post-breakfast or -dinner two or three times per week.
• Insulin therapy—the frequency is based somewhat on the insulin regimen and blood sugar stability:
One daily injection—one to three tests daily (at least two recommended).
Two daily injections—four tests daily (before meals and at bedtime). Stable patients on fixed doses can perform four times per day, three days a week, including some weekends.
Intensive therapy (multiple injections or insulin pump)—four to seven times per day. Stabilized patients on fixed insulin doses may test four times daily three days per week, including a weekend day.
• Patients with asymptomatic nocturnal hypoglycemia should perform their bedtime fingerstick measurement 1 '/2 hours after their evening snack. They should also check between 1 a.m. and 3 a.m. on days following unusual exercise.
• Patients who test infrequently should increase the frequency when ill, traveling, changing daily routine, or having problems with hypo- or hyperglycemia, or after intense exercise.
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