Monitoring diabetes
Diabetes Outreach
(March 2011)
Monitoring diabetes
Learning outcomes
> Define the purpose, methods and targets for blood
glucose monitoring.
> Understand the recommended frequency for testing in
hospital and at home.
> Be able to interpret results and identify appropriate
action.
> Understand when to test ketones.
> Understand the need for quality assurance programs.
> Be aware of the long term management of diabetes.
2
Monitoring diabetes control
> Monitoring diabetes evaluates progress for
the adjustment of therapy and lifestyle.
> Monitoring diabetes includes:
- diet
- activity
- clinical signs and symptoms
- ketones
3
Monitoring diabetes control
Controlling diabetes is important for:
> health and a sense of well being for the
individual
> normal growth and development in children
and adults
> normal outcomes of pregnancy
> lowering the incidence of illness and
hospitalisation
> prevention of long term complications.
4
Blood glucose monitoring
>
>
>
>
>
Can not be used to diagnose diabetes
Can assist in therapeutic decision making
Can detect hypoglycaemia
Accurate technique is essential
People can monitor their own BGLs at home.
5
What are the BG targets?
Recommendations
> The general HbA1c target in people with type 2 diabetes
is ≤7%. Adjustment to diabetes treatment should be
considered when HbA1c is above this level.
> Targets for self-monitored blood glucose levels are 68mmol/L fasting and preprandial, and 6-10mmol/L 2hr
postprandial.
Practice point
>
An HbA1c target above 7% may be appropriate in people with type
2 diabetes who have a history of severe hypoglycaemia, a limited
life expectancy, co-morbidities or who are elderly.
Ref: NHMRC guidelines 2009 National evidence based guidelines for
blood glucose
6
BG monitoring in health
services/hospital
> Health professionals should be competent in the
use of blood glucose meters (eg biannual
accreditation process).
> Health services should adopt a quality
assurance program to ensure accuracy of
results.
> All patients with diabetes should have BGL’s
monitored regularly whilst in hospital.
7
Self blood glucose monitoring
> All people with diabetes using insulin therapy or
who are at risk of hypoglycaemia should be
encouraged to test their own BGL’s.
> For all other people appropriateness for SBGM
should be assessed on an individual basis.
> Individuals using blood glucose meters at home
should have access to adequate self
management education.
8
Blood glucose monitoring in
hospital
> Aim for BGL’s between 5 and 10mmol/L.
> Check BGLs pre meal and 2100 hours unless
patient is fasting and on IV insulin.
> Frequency of monitoring in hospital should be
assessed and documented regularly.
> Notify MO if BGL >15mmol/L on 2 consecutive
readings or >20mmol/L.
9
Blood glucose monitoring at
home
The targets and frequency of testing will depend
on what type of diabetes the person has, the type
of treatment they are on (diet, tablets or insulin)
and the intensity of their regimen.
What might you suggest for a person who is on
basal insulin only?
10
Example: Home blood glucose
testing
DAY
FASTING BEFORE
LUNCH
Monday
x
Tuesday
x
x
Wednesday
Thursday
Friday
x
x
Saturday
x
Sunday
x
BEFORE
DINNER
BEFORE
BED
2-3am
x
x
x
x
x
x
11
Ketone testing
Essential in those with type 1 diabetes.
> Perform if unwell and/or BGL’s exceed
15mmol/L.
> Report moderate levels of ketones to medical
practitioner.
> Watch for signs of dehydration and treat as
required.
12
Interpreting results once home
> If non-fasting BGL’s are regularly above
8mmol/L then diabetes management should be
reviewed.
> If BGL >15mmol/L check ketones if type 1
diabetes.
> BGL <4mmol/L (treat for ‘hypo’ even if no
symptoms present).
13
Accuracy and quality assurance
> Ensure blood glucose level accuracy by regular
quality control testing.
> Nurses are responsible for ensuring QA is
maintained.
> User’s should therefore be accredited.
14
Glycated haemoglobin
(HbA1c)
> HbA1c is a laboratory test which is used to
check long term glycaemic control.
> HbA1c recommended target is less than 7%
> Testing is recommended 3-6 monthly.
15
Long term monitoring
>
>
>
>
Yearly total cholesterol <4.0mmol/L.
Blood pressure checks <130/80.
Yearly microalbumin & creatine/urea levels.
6 months foot review of circulation, sensitivity,
reflexes and skin.
> 2 yearly ophthalmology review.
16
References
> ADEA (2010) Position statement. Use of blood
glucose meters, Canberra.
> RACGP (2010/2011), Diabetes management in
general practice, Canberra.
> Diabetes Outreach (2009), Diabetes Manual,
Section 4, Section 5, Section 11.
17
18