DOCSLIB.ORG

Standards of Medical Care in Diabetes—2019 Abridged for Primary Care Providers American Diabetes Association

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Standards of Medical Care in Diabetes—2019 Abridged for Primary Care Providers American Diabetes Association POSITION STATEMENT Standards of Medical Care in Diabetes—2019 Abridged for Primary Care Providers American Diabetes Association he American Diabetes Associa- 1. IMPROVING CARE AND tion’s (ADA’s) Standards of Med- PROMOTING HEALTH IN Tical Care in Diabetes is updated POPULATIONS and published annually in a supple- Diabetes and Population Health ment to the January issue of Diabetes Care. The ADA’s Professional Practice Recommendations Committee, which includes physi- • Ensure treatment decisions are cians, diabetes educators, registered timely, rely on evidence-based dietitians (RDs), and public health guidelines, and are made collab- experts, develops the Standards. The oratively with patients based on Standards include the most current individual preferences, prognoses, evidence-based recommendations for and comorbidities. B diagnosing and treating adults and • Align approaches to diabetes children with all forms of diabetes. management with the Chronic ADA’s grading system uses A, B, C, Care Model, emphasizing pro- or E to show the evidence level that ductive interactions between a supports each recommendation. prepared proactive care team and A • A—Clear evidence from well- an informed activated patient. • Care systems should facilitate conducted, generalizable ran- team-based care, patient regis- domized controlled trials that are tries, decision support tools, and adequately powered community involvement to meet • B—Supportive evidence from patient needs. B well-conducted cohort studies • C—Supportive evidence from Population health is defined as poorly controlled or uncontrolled “the health outcomes of a group of studies individuals, including the distribution • E—Expert consensus or clinical of health outcomes within the group”; experience these outcomes can be measured in This is an abridged version of the American terms of health outcomes (mortality, Diabetes Association’s Standards of Medical This is an abridged version of morbidity, health, and functional sta- Care in Diabetes—2019. Diabetes Care the 2019 Standards containing the 2018;42(Suppl. 1):S1–S194. tus), disease burden (incidence and evidence-based recommendations The complete 2019 Standards supplement, prevalence), and behavioral and meta- including all supporting references, is most pertinent to primary care. The bolic factors (exercise, diet, A1C, etc.). available at professional.diabetes.org/ tables and figures have been renum- Clinical practice recommendations standards. bered from the original document for health care providers are tools that https://doi.org/10.2337/cd18-0105 to match this version. The complete can ultimately improve health across ©2018 by the American Diabetes Association. 2019 Standards of Care document, populations; however, for optimal Readers may use this article as long as the work is including all supporting references, outcomes, diabetes care must also be properly cited, the use is educational and not for profit, and the work is not altered. See www. is available at professional.diabetes. individualized for each patient. Thus, diabetesjournals.org/content/license for details. org/standards. efforts to improve population health CLINICAL DIABETES 1 Clinical Diabetes Online Ahead of Print, published online December 17, 2018 POSITION STATEMENT will require a combination of system- Tailoring Treatment for Social 2. CLASSIFICATION AND level and patient-level approaches. Context DIAGNOSIS OF DIABETES Diabetes can be classified into the The proportion of patients with Recommendations diabetes who achieve recommended following general categories: • Providers should assess social A1C, blood pressure, and LDL cho- 1. Type 1 diabetes (due to auto- context, including potential food lesterol levels has increased in recent immune β-cell destruction, insecurity, housing stability, and years. Nevertheless, a 2013 report usually leading to absolute insulin financial barriers, and apply that found that 33–49% of patients still deficiency) information to treatment deci- did not meet general targets for gly- 2. Type 2 diabetes (due to a progres- sions. A cemic, blood pressure, or cholesterol sive loss of β-cell insulin secretion control, and only 14% met targets for • Refer patients to local community frequently on the background of B all three measures while also avoiding resources when available. insulin resistance) smoking. • Provide patients with self- 3. Gestational diabetes mellitus Diabetes poses a significant management support from lay (GDM) (diabetes diagnosed in the financial burden to individuals and health coaches, navigators, or second or third trimester of preg- society. After adjusting for inflation, community health workers when nancy that was not clearly overt A economic costs of diabetes increased available. diabetes prior to gestation) 4. Specific types of diabetes due to by 26% from 2012 to 2017. This is Health inequities related to other causes, e.g., monogenic dia- attributed to the increased prevalence diabetes and its complications are betes syndromes (such as neonatal of diabetes and the increased cost per well documented and are heavily diabetes and maturity-onset diabe- person with diabetes. influenced by social determinants tes of the young), diseases of the The Chronic Care Model (CCM) of health. Social determinants of exocrine pancreas (such as cystic is an effective framework for improv- health are defined as the economic, ing the quality of diabetes care and fibrosis and pancreatitis), and drug- environmental, political, and social or chemical-induced diabetes (such includes six core elements: conditions in which people live and 1. as with glucocorticoid use, in the Delivery system design (moving are responsible for a major part of from a reactive to a proactive care treatment of HIV/AIDS, or after health inequality worldwide. delivery system where planned organ transplantation) Food insecurity (FI) is the unre- visits are coordinated through a liable availability of nutritious food Diagnostic Tests for Diabetes team-based approach) and the inability to consistently 2. Self-management support Recommendations obtain food without resorting to 3. Decision support (basing care • Testing for prediabetes and type socially unacceptable practices. FI on evidence-based, effective care 2 diabetes in asymptomatic peo- affects more than 14% of the U.S. guidelines) ple should be considered in adults population, with higher rates in 4. Clinical information systems of any age who are overweight or some racial/ethnic minority groups, 2 (using registries that can provide obese (BMI ≥25 kg/m or ≥23 patient-specific and population- in low-income households, and in kg/m2 in Asian Americans) and based support to the care team) homes headed by a single mother. who have one or more additional FI is associated with increased 5. Community resources and pol- risk factors for diabetes (Table 1). B icies (identifying or developing risk for type 2 diabetes, subopti- • For all people, testing should begin resources to support healthy mal glycemic control, psychosocial at age 45 years. B lifestyles) conditions, and low treatment • If tests are normal, repeat testing 6. Health systems (to create a quality- adherence. carried out at a minimum of 3-year oriented culture) Community health workers intervals is reasonable. C (CHWs), peer supporters, and lay • In patients with prediabetes and Redefining the roles of the health leaders may assist in the delivery of type 2 diabetes, identify and, if care delivery team and empow- diabetes self-management education appropriate, treat other cardiovas- ering patient self-management and support (DSMES) services, cular disease risk factors. B are fundamental to the success- particularly in underserved com- • Risk-based screening for prediabe- ful implementation of the CCM. munities. CHWs can be part of a tes and/or type 2 diabetes should Collaborative, multidisciplinary cost-effective, evidence-based strat- be considered after the onset of teams are best suited to provide care egy to improve the management of puberty or after 10 years of age, for people with chronic conditions diabetes and cardiovascular risk whichever occurs earlier, in chil- such as diabetes and to facilitate factors in underserved communi- dren and adolescents who are patients’ self-management. ties and health care systems. overweight (BMI ≥85th percentile) 2 CLINICAL.DIABETESJOURNALS.ORG Clinical Diabetes Online Ahead of Print, published online December 17, 2018 ABRIDGED STANDARDS OF CARE 2019 TABLE 1. Criteria for Testing for Diabetes or Prediabetes in Asymptomatic Adults 1. Testing should be considered in overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) adults who have one or more of the following risk factors: • First-degree relative with diabetes • High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander) • History of CVD • Hypertension (≥140/90 mmHg or on therapy for hypertension) • HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L) • Women with polycystic ovary syndrome • Physical inactivity • Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans) 2. Patients with prediabetes (A1C ≥5.7% [39 mmol/mol], IGT, or IFG) should be tested yearly. 3. Women who were diagnosed with GDM should have lifelong testing at least every 3 years. 4. For all other patients, testing should begin at age 45 years. 5. If results are normal, testing should be repeated at a minimum of 3-year intervals,
Load more

Recommended publications
  • Management of Diabetes Mellitus Standards of Care and Clinical Practice Guidelines
    WHO-EM/DIN6/E/G MANAGEMENT OF DIABETES MELLITUS STANDARDS OF CARE AND CLINICAL PRACTICE GUIDELINES Edited by Dr A.A.S. Alwan Regional Adviser, Noncommunicable Diseases WHO Regional Office for the Eastern Mediterranean WHO-EM/DIN6/E/G INTRODUCTION Available data from many countries of the Eastern Mediterranean Region (EMR) indicate that diabetes mellitus has become a problem of great magnitude and a major public health concern. Studies have demonstrated that, in some countries, diabetes affects up to 10% of the population aged 20 years and older. This rate may be doubled if those with impaired glucose tolerance (IGT) are also included. The manifestations of diabetes cause considerable human suffering and enormous economic costs. Both acute and late diabetic complications are commonly encountered. Long-term complications represented by cardiovascular diseases, cerebrovascular accidents, end-stage renal disease, retinopathy and neuropathies are already major causes of morbidity, disability and premature death in countries of this Region. The development of long-term complications is influenced by hyperglycaernia. Poor control of diabetes accelerates their progression. Thus, to prevent complications, good control of diabetes is essential and the management of diabetes should therefore aim to improve glycaemic control beyond that required to control its symptoms. Intensified therapy and maintaining near-normal blood glucose levels can result in considerable reduction in the risk of development of retinopathy, nephropathy and neuropathy. However, despite the high prevalence of diabetes and its complications and the availability of successful prevention strategies, essential health care requirements and facilities for self-care are often inadequate in this Region. Action is needed at all levels of health care and in the various aspects of diabetes care to bridge this gap and to improve health care delivery to people with diabetes.
    [Show full text]
  • 2015 Prediabetes Data Summary
    The Georgia Department of Public Health Prediabetes Data Summary Diabetes is the 6th leading cause of death among adults and over 800,000 people live with diabetes in Georgia.1 Individuals with prediabetes have an increased risk of developing Type 2 diabetes, heart disease and stroke. Moreover, individuals with prediabetes often possess cardiovascular risk factors such as hypertension, obesity and high cholesterol. Prediabetes almost always occurs among individuals who eventually develop Type 2 diabetes.2 In Type 2 diabetes, the body does not use insulin properly which causes blood glucose (sugar) levels to be higher than normal. Approximately 450,000 adults in Georgia have prediabetes. Prediabetes (also known as borderline diabetes) is a medical condition that occurs when blood glucose levels are higher than normal, but are not high enough to be diagnosed as diabetes.3 Test results among individuals diagnosed with prediabetes include: A1C test value: 5.7% - 6.4% Impaired fasting blood glucose (IFG) levels: 100-125 mg/dl OR Two- hour Oral Glucose Tolerance Test (OGTT) value: 140 mg/dl – 199 mg/dl Making healt hy lifestyle choices, such as eating healthy foods, being physically active and maintaining a healthy weight, may help to bring blood glucose (sugar) levels down to normal and decrease the risk of developing Type 2 diabetes Table 1. Demographic Characteristics among Prediabetics, Georgia, 2013 Demographic Characteristics Percent (%) 95% CI State Total 7.9 (7.2, 8.9) Sex Male 7.8 (6.8, 9.5) Female 7.9 (6.9, 9.1) Race/Ethnicity
    [Show full text]
  • Effect of Continuous Glucose Monitoring on Hypoglycemia in Type 1 Diabetes
    Clinical Care/Education/Nutrition/Psychosocial Research ORIGINALDiabetes ARTICLE Care Publish Ahead of Print, published online February 19, 2011 Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes 1 2 TADEJ BATTELINO, MD, PHD REVITAL NIMRI, MD especially useful in patients with hypogly- 2 3 MOSHE PHILLIP, MD PER OSKARSSON, MD, PHD 1 3 cemia unawareness and/or frequent epi- NATASA BRATINA, MD, PHD JAN BOLINDER, MD, PHD sodes of hypoglycemia (18). However, the hypoglycemia preventive effect of con- tinuous glucose monitoring has not been — OBJECTIVE To assess the impact of continuous glucose monitoring on hypoglycemia in established. Therefore, we designed a ran- people with type 1 diabetes. domized, controlled, multicenter clinical RESEARCH DESIGN AND METHODS—In this randomized, controlled, multicenter trial to evaluate the effect of continuous study, 120 children and adults on intensive therapy for type 1 diabetes and a screening level of glucose monitoring on hypoglycemia in glycated HbA1c ,7.5% were randomly assigned to a control group performing conventional children and adults with type 1 diabetes. home monitoring with a blood glucose meter and wearing a masked continuous glucose monitor every second week for five days or to a group with real-time continuous glucose monitoring. The primary outcome was the time spent in hypoglycemia (interstitial glucose concentration ,63 RESEARCH DESIGN AND mg/dL) over a period of 26 weeks. Analysis was by intention to treat for all randomized patients. METHODS RESULTS—The time per day spent in hypoglycemia was significantly shorter in the contin- uous monitoring group than in the control group (mean 6 SD 0.48 6 0.57 and 0.97 6 1.55 Patients Patients aged between 10 and 65 years h/day, respectively; ratio of means 0.49; 95% CI 0.26–0.76; P = 0.03).
    [Show full text]
  • Glossary of Common Diabetes Terms
    Glossary of Common Diabetes Terms A1C: a test that reveals exactly how well your blood sugar (glucose) has been controlled over the previous three months Beta cells: cells found in the pancreas that make insulin Blood glucose: also known as blood sugar, glucose comes from food and is then carried through the blood to deliver energy to cells Blood glucose meter: a small medical device used to check blood glucose levels Blood glucose monitoring: the simple blood test used to check the amount of glucose in the blood; a tiny drop of blood, taken by pricking a finger, is placed on a test strip and inserted in the meter for reading Diabetes: the shortened name for diabetes mellitus, the condition in which the pancreas doesn’t produce enough insulin or your body is unable to use insulin to move glucose into cells of the body Diabetic retinopathy: the eye disease that occurs in someone with diabetes when the small blood vessels of the retina become swollen and leak liquid into the retina, blurring vision; it can sometimes lead to blindness Gestational diabetes: the diabetes some women develop during pregnancy; it typically subsides after the baby is delivered, but many women who have had gestational diabetes may develop type 2 diabetes later in life Glucagon: the hormone that is injected into a person with diabetes to raise their blood glucose level when it’s very low (hypoglycemia) Glucose: blood sugar that gives energy to cells Hyperglycemia: also known as high blood glucose, this condition occurs when your blood glucose level is too high;
    [Show full text]
  • Clinical Use of Hemoglobin A1c to Improve Diabetes Management
    PRACTICAL POINTERS Clinical Use of Hemoglobin A1c to Improve Diabetes Management Alan M. Delamater, PhD, ABPP or more than 25 years, the hemo- one recent study conducted in Norway6 A1C values. Only 14% of the youths globin A1c (A1C) test has been revealed that the majority (82.6%) of were able to accurately describe the A1C Fthe most widely accepted out- 201 adult patients with type 1 diabetes test. Just 11, 7.8, and 7.8% correctly come measure for evaluating glycemic knew what their last A1C was, and most identified the A1C ranges for good, fair, control in individuals with diabetes. patients (90%) knew what a satisfactory and poor glycemic control, respectively. The test provides an index of a patient’s A1C value would be. But a significant Very few youths (1.6–3.2%) knew the average blood glucose level during the number of patients (42%) reported they blood glucose values corresponding to past 2–3 months1 and is considered to had low knowledge of A1C testing in specific A1C results. Only a small num- be the most objective and reliable general. Furthermore, 25% of patients ber of youths correctly estimated the measure of long-term metabolic con- did not think that treatment intensifica- short- and long-term risks associated trol.2,3 The Diabetes Control and tion should occur at an A1C value of with A1C values of 7 and 12%. In this Complications Trial established that 10%. sample, there was a significant lack of maintaining A1C levels as close as pos- A recent cross-sectional study knowledge concerning the meaning and sible to the normal range results in con- examined the relationship between implications of the A1C test.
    [Show full text]
  • Food Fact Sheet
    Food Fact Sheet Diabetes - Type 2 What is Type 2 diabetes? Diabetes is a condition where the amount of glucose (sugar) in your blood is too high because your body cannot use it properly. In Type 2 diabetes this happens because your pancreas doesn’t produce enough of the hormome insulin (that helps glucose enter body cells) and/or the insulin that is produced does not work correctly (insulin resistance). The importance of good blood glucose control 2 Reduce your portion sizes to help you reduce and People with Type 2 diabetes need to control their maintain a healthy weight. blood glucose. It is also important to look after your A portion is: heart health. Making changes to your lifestyle, diet and • a fist size of potatoes, bread, pasta or other activity level can be key to reducing the risk of diabetes starchy carbohydrates causing you problems now and in the future. • a palm size of meat/fish or poultry What can you eat? • two handfuls of vegetables or salad • a cupped-handful of fruit People with diabetes should eat a healthy diet, the • top of your thumb size of oil or fat spread. same as somebody without diabetes. It should be low Try using a smaller plate, filling half of your plate with in saturated fat, high in fibre and include a variety of vegetables and avoiding second helpings. fruit and vegetables. 3 Carbohydrates are used for energy so include some The eatwell guide in your diet each day. Opt for wholegrain options, fruits and vegetables, beans, pulses, low fat milk and The eatwell guide represents the main food groups and yoghurt.
    [Show full text]
  • Comparative Evaluation of Fructosamine and Hba1c As a Marker of Glycemic Control in Type 2 Diabetes: a Hospital Based Study
    International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Comparative Evaluation of Fructosamine and HbA1c as a Marker of Glycemic Control in Type 2 Diabetes: A Hospital Based Study Dr. Jyoti Goyal1, Dr. Nibhriti Das2, Dr. Navin Kumar3, Ms. Seema Raghav4, Dr. Paramjeet Singh Bhatia5, Dr. Karunesh Prasad Singh6, Dr. Sabari Das7 1DNB, Department of Internal Medicine, Nayati Healthcare and Research Centre, Mathura, India- 281003, 2Ex-Director of Laboratory services and Additional Dean Research and Academics, Nayati Healthcare and Research Centre, Mathura, India- 281003, 3Ph.D, Biostatistitian, Department of Biostatistics, Nayati Healthcare and Research Centre, Mathura, India-281003. 4M.Sc., Certified Diabetes Educator, Department of Internal Medicine, Nayati Healthcare and Research Centre, Mathura, India-281003. 5MD, Department of Internal Medicine, Nayati Healthcare and Research Centre, Mathura, India-281003. 6MD Physician, Department of Internal Medicine, Nayati Healthcare and Research Centre, Mathura, India-281003. 7Department of Laboratory Medicine, Nayati Healthcare and Research Centre, Mathura, India- 281003, Corresponding Author: Dr. Jyoti Goyal ABSTRACT Introduction: Management of type 2 diabetes revolves around achievement of target glycemic control with the help of antidiabetic drugs or insulin. There are various markers for measurement of glyceamic control like HbA1c, Mean Blood Glucose and fructosamine levels. Though HbA1c is a well validated standard method for assessment of glycemic control but it has also got certain limitations. Fructosamine, a less explored method may be used as an alternative marker for an assessment of glycemic control in cases where HbA1c is unreliable or unavailable. The objective of this study is to compare the fructosamine levels with HbA1c in assessment of glycemic control in type 2 diabetics so as to assess the utility of fructosamine as an alternative marker for evaluation of glucose control.
    [Show full text]
  • Metformin for Prediabetes
    FACT SHEET FOR PATIENTS AND FAMILIES Metformin for Prediabetes What is metformin? Metformin [met-FORE-min] is a medication that is often prescribed for prediabetes in order to help prevent type 2 diabetes. It is taken by mouth (orally) as a pill. Like other prediabetes medications, it works best when you follow the rest of your treatment plan, like improving your nutrition by eating more fruits and vegetables, being physically active every day, and in most cases, losing weight. What does it do? Metformin helps lower your blood glucose (blood sugar). It does this by: Does metformin cause hypoglycemia • Decreasing the amount of glucose released by your (low blood glucose)? liver. Less glucose enters into your bloodstream. No. Metformin doesn’t cause hypoglycemia by itself. • Increasing the ability of your muscles to use glucose But combined with other medications, vigorous for energy. As more glucose is used, more glucose exercise, or too little food, it can make your blood leaves your bloodstream. glucose drop too low. Why is metformin important Since low blood glucose can be dangerous, make sure for my health? that you and your family know the symptoms. These include feeling shaky, sweaty, hungry, and irritable. Metformin can’t cure your prediabetes. But, by If you have these symptoms, take some quick-acting helping control your blood glucose, it can help sugar. Good sources are 3 or 4 glucose tablets, a half- prevent type 2 diabetes, especially among those at cup of fruit juice or regular soda, or a tablespoon of highest risk for developing type 2 diabetes.
    [Show full text]
  • Prediabetes: What Is It and What Can I Do?
    Prediabetes: What Is It and What Can I Do? What is prediabetes? Weight loss can delay or prevent diabetes. Prediabetes is a condition that comes before Reaching a healthy weight can help you a lot. diabetes. It means your blood glucose levels are If you’re overweight, any weight loss, even higher than normal but aren’t high enough to be 7 percent of your weight (for example, losing called diabetes. about 15 pounds if you weigh 200), may lower your risk for diabetes. There are no clear symptoms of prediabetes. You can have it and not know it. If I have prediabetes, what does it mean? It means you might get type 2 diabetes soon or down the road. You are also more likely to get heart disease or have a stroke. The good news is that you can take steps to delay or prevent type 2 diabetes. How can I delay or prevent type 2 diabetes? You may be able to delay or prevent type 2 diabetes with: Daily physical activity, such as walking. Weight loss, if needed. Losing even a few pounds will help. Medication, if your doctor prescribes it. If you have prediabetes, these steps may bring your blood glucose to a normal range. But you are still at a higher risk for type 2 diabetes. Regular physical activity can delay or prevent diabetes. Being active is one of the best ways to delay or prevent type 2 diabetes. It can also lower your weight and blood pressure, and improve cholesterol levels. Ask your health care team about activities that are safe for you.
    [Show full text]
  • Glossary of Technical Terms
    THIS DOCUMENT IS IN DRAFT FORM, INCOMPLETE AND SUBJECT TO CHANGE AND THAT THE INFORMATION MUST BE READ IN CONJUNCTION WITH THE SECTION HEADED “WARNING” ON THE COVER OF THIS DOCUMENT. GLOSSARY OF TECHNICAL TERMS This glossary contains explanations of certain technical terms used in this Document in connection with our Company and its business. Such terminology and meanings may not correspond to standard industry meanings or usages of those terms. “acetaminophen” a non-opioid analgesic and antipyretic agent used to treat pain and fever “artificial pancreas” an integrated diabetes management system that tracks blood glucose levels using a continuous glucose monitor and automatically delivers the insulin when needed using an insulin pump according to its control algorithm “ascorbic acid” a potent reducing and antioxidant agent that functions in fighting bacterial infections, in detoxifying reactions, and in the formation of collagen in fibrous tissue, teeth, bones, connective tissue, skin, and capillaries “basal insulin” a small, continuous infusion of background insulin delivered automatically at a programmed rate, all day and night “BG Port” blood glucose strip port, the port that accepts and electrically connects a disposable blood glucose strip to the electronics “BGMS” blood glucose monitoring system “BLE” bluetooth low energy “blood glucose” blood glucose, also referred to as blood sugar, is the amount of glucose in your blood, an indicator of diabetes monitoring “bolus insulin” insulin that is taken to lower abnormally high blood glucose
    [Show full text]
  • Blood Glucose Monitoring in Type 1 Diabetes (Adults)
    FACTSHEET | JUNE 2021 Blood Glucose Monitoring in type 1 diabetes (adults) RSS Diabetes Service Blood glucose goes up and down during the day depending on carbohydrate intake, physical activity, insulin doses, wellbeing and stressors. Blood glucose results tend to be lower before meals and higher after meals. Blood glucose monitoring guides your self-care. The first step in blood glucose monitoring is knowing your blood glucose target ranges. What are the recommended blood glucose (BG) targets For most people with type 1 diabetes, it is recommended that blood glucose be as close to normal as possible to reduce the risk of long term complications. In general, recommended blood glucose targets are: Time Target BG Fasting and before meals 4.0 – 8.0mmol/L 2 hours after meals 4.0 – 10.0mmol/L However, for some people (e.g. infants and young children, the aged, those with impaired hypoglycaemia awareness or other health conditions), blood glucose targets will need to be set higher. If you are pregnant or trying to get pregnant, your blood glucose targets will be set lower. When should I test my blood glucose (BG)? Your blood glucose levels will indicate if your diabetes is well managed or if changes are needed. Blood glucose results overnight or before breakfast tell you how well your diabetes is controlled overnight by the basal insulin. Blood glucose results before lunch, before the evening meal and at bedtime tell you if your meal time rapid acting insulin doses are correct. Extra tests are recommended if you: • feel unwell, as part of your sick day action plan • are planning some physical activity, during and after physical activity • are using machinery • are about to drive • are concerned about unstable, unexpected or unexplainable results.
    [Show full text]
  • Blood Glucose Monitoring
    Blood Glucose Monitoring Many people are frightened to check their blood sugar levels because they do not want to see levels that are higher or lower than their target range. However, checking your blood sugars puts you in control of your diabetes. Remember, your blood sugar levels are what they are whether you know about them or not but when you know what they are; you can make adjustments, if needed. Monitoring your blood sugar levels is the most accurate way of you seeing the effectiveness of your lifestyle changes and medications. Monitoring provides you with the ability to identify possible causes of blood sugar fluctuations. Tips for Monitoring • Wash your hands with soap in warm water before checking your blood sugar • Ensure your test strips have not expired • Remember to calibrate your meter (if your meter requires this) • Use the sides of your fingers and remember to use different fingers o Do not use alternate site testing if you think your blood sugar is very high or low – finger checks give you the most accurate result • Discuss the with your healthcare team the best times to check your blood sugar level – which may include: o Prior to your meal and / or 2 hours after the meal o Overnight o If you feel unwell • Record your results in a logbook; this will help you to identify patterns in your levels and make the required changes to get your blood sugar back to your target range; bring your blood sugar records and meter(s) to your healthcare visit - it will help you and your healthcare team to determine your diabetes management needs.
    [Show full text]