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In the past, urine tests were the only way to check diabetes control at home and were not very accurate. Urine tests cannot tell the exact blood sugar level, and they cannot tell low blood sugar levels. They can only tell whether there has been excessive sugar in the blood at some time since last emptying the bladder.
Self monitoring of blood glucose is considered by many to be the greatest innovation in diabetes. It allows patients to take control of the disease, since everything they do and everything that happens to them affects their blood sugar. The two methods of self-monitoring are meter testing and visual testing.
There are many different types of testing meters available. A strip with a drop of blood, usually from the fingertip, is inserted into the meter to obtain the blood glucose level. This method of testing provides an exact reading of the blood sugar level.
Visual testing is done with a strip having a soft chemically treated pad. When a drop of blood is placed on the pad, chemicals cause the pad to change color when it comes in contact with sugar. The strip is then compared to a color chart to identify the amount of blood sugar.
Variation in blood glucose readings is normal for someone with diabetes. Some meters and strips measure plasma glucose, while others measure blood glucose. It is obviously important for the diabetic to know which type of glucose is being measured.
Patients are encouraged to keep a record of their blood glucose levels and other information, like their diet and exercise, which may cause changes in their blood glucose levels. This information helps the doctor assess the effectiveness of the therapy and make any needed adjustments to treatment.
Recommendations for self-monitoring include the following:
– all insulin patients should test.
– Type 1 diabetics should test at least three times a day.
– all patients not achieving blood glucose goals should test.
– both Type 1 and 2 patients should test more often than usual when modifying therapy.
Continuous glucose monitoring (CGM) systems use a tiny sensor inserted under the skin to check glucose levels in tissue fluid. The sensor stays in place for several days to a week and then must be replaced. A transmitter sends information about glucose levels via radio waves from the sensor to a pagerlike wireless monitor. The user must check blood samples with a glucose meter to program the devices. Because currently approved CGM devices are not as accurate and reliable as standard blood glucose meters, users should confirm glucose levels with a meter before making a change in treatment.
CGM systems are more expensive than conventional glucose monitoring, but they may enable better glucose control. CGM devices produced by Abbott, DexCom, and Medtronic have been approved by the U.S. Food and Drug Administration (FDA) and are available by prescription. These devices provide real-time measurements of glucose levels, with glucose levels displayed at 5-minute or 1-minute intervals. Users can set alarms to alert them when glucose levels are too low or too high. Special software is available to download data from the devices to a computer for tracking and analysis of patterns and trends, and the systems can display trend graphs on the monitor screen.
Unfortunately, data indicates that only a minority of patients perform self-monitoring of their blood glucose levels. Barriers to self testing are thought to include the cost of the testing, physical discomforts associated with the testing, inadequate understanding about the health benefits, and the general inconvenience of doing such testing (the time involved and complexity of technique).
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