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SBGM is a necessary evil that makes having diabetes particularly difficult. Despite considerable improvement in meters over the past few years, the pain, inconvenience, expense, and sometimes emotional upset caused by a "bad blood sugar" make doing SBGM one of the most hated parts of the treatment program. Physicians need to discuss this issue openly with their patients. My own practice recommends four daily tests (pre-meal alternating with post-meal, and pre-bed) when insulin programs are initiated or changed, or when variable daily glycemia prevents obtaining the target HbAk. Also, the presence of hypoglycemia un-awareness mandates frequent testing. I impress on patients that the tests are done for them—they need to know how different aspects of their lifestyle affect their blood glucose level. I also recommend the patient set aside a time to review and analyze that day's tests, often with the spouse so that there is a family approach to taking care of the patient's diabetes. Don't make die mistake of leaving analysis of the SBGM entirely up to patients and not reviewing their logs when they come to see you. You want to know that blood testing is being done, and that patients are correctly identifying problem patterns. Also, patients often complain, "I do my blood tests, but my doctor never looks at them." It's hard to convince a patient to make a change in his or her treatment program if the doctor is viewed as uninterested.

Once the target HbAlc is attained without problematic hypoglycemia, the frequency of SBGM is reduced for patients who find it onerous, although this ends up being relatively few. The common usage of mealtime algorithms based on glycemia requires testing at each meal. Also, persons with fluctuating blood sugars, a reduced perception of hypoglycemia, or lifestyles with sizable variations in diet or activity should continue to test frequently. In reality, this rarely is a contentious issue because most patients use their readings almost like a warning light in a car to know that their diabetes is under control.

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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