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Self-Monitoring of Blood Glucose (SMBG)

Controlling your blood glucose level is a very important part of managing diabetes. Regularlytesting your blood glucose helps measure the effectiveness of your meal plan, physical activity andmedications.

Self-monitoring of blood glucose (SMBG) is an important & integral component of modern therapyfor diabetes mellitus. SMBG has been recommended for people with diabetes in order to achieve atarget level of glycemic control and thus achieve their HbA1c target. The goal of SMBG is toachieve target HbA1c by regularly monitoring blood glucose levels at different time intervals so asto check short term glycemic changes and enable maintenance of a more constant glucose level.

By self-monitoring your blood glucose one can measure how the body handles different types offood, exercise, medication, stress and illness. Your blood glucose result may prompt you to eat asnack, take more insulin or go for a walk. Self-monitoring can also alert you to a blood glucoselevel that is too high or too low, which requires special treatment.

The results of self-monitoring can help guide you and your healthcare team to adjust the manyparts of your therapy.

To self-test your blood glucose, you need a blood glucose meter, a test strip and a lancing device.Then, follow these basic steps: 1

Wash and dry your hands. Using warm water may help increase the blood flow to yourfingertips.

Follow the instructions included with your lancing device to get a drop of blood whichnormally include shaking your hands below the wrist or gently squeezing your finger afew times to help.

Apply the blood drop to the test strip as directed Wait a few seconds to view your results Dispose of the lancet and test strip in the proper manner

While testing from the tip of a finger is most common, it is possible to use alternate site testing (AST ). Other methods of testing and monitoring look at your blood glucose in the long-term. AnHbA1c (also known as glycated haemoglobin or A1c) test gives you a picture of your average bloodglucose control for the past 2 to 3 months.

1 Joslin Diabetes Center. Blood glucose monitoring: your tool for diabetes control. Available at:

http://www.joslin.org/managing_your_diabetes_650.aspAccessed January 10, 2010.

2American Diabetes Association. A1C test, Availablehttp://www.diabetes.org/type-1-diabetes/a1c-test.jspAccessedNovember 11, 2008.

Alternative Site Testing (AST)

Some blood glucose meters allow you to use blood samples from other parts of the body, such as

the palm, forearm, upper arm, thigh or calf. Testing from alternate sites is not always ideal. Bloodfrom your fingertip shows changes in blood glucose quickly, but blood from alternate sites maynot, and you may not get the most accurate result.1 Always consult with your healthcareprofessional before using sites other than your fingertip for blood glucose testing

Alternate site testing, or AST, may be recommended when blood glucose is stable, such asimmediately before a meal or before bedtime. AST is not recommended when blood glucose ischanging quickly, such as immediately after a meal or after physical activity.

Never ignore symptoms of low or high blood glucose levels. If your blood glucose test result doesnot match the way you feel, perform a fingertip test to confirm the result.

http://www.joslin.org/managing_your_diabetes_650.asphttp://www.joslin.org/managing_your_diabetes_650.asphttp://www.diabetes.org/type-1-diabetes/a1c-test.jsphttp://www.diabetes.org/type-1-diabetes/a1c-test.jsphttp://www.diabetes.org/type-1-diabetes/a1c-test.jsphttp://www.diabetes.org/type-1-diabetes/a1c-test.jsphttp://www.joslin.org/managing_your_diabetes_650.asp

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1 American Diabetes Association. Standards of medical care in diabetes-2008.Diabetes Care. 2007;31:S12S54. Available at:http://www.joslin.org/info/monitoring_your_blood_glucose.html(accessed January 24, 2008).

Why Self Monitor?

Self-monitoring of blood glucose (SMBG) is an important & integral component of modern therapyfor diabetes mellitus. SMBG has been recommended for people with diabetes in order to achieve atarget level of glycemic control and thus achieve their HbA1c target.

The goal of SMBG is to achieve target HbA1c by regularly monitoring blood glucose levels atdifferent time intervals so as to check short term glycemic changes and enable maintenance of a

more constant glucose level. This can help the healthcare professionals in the adjustment of atherapeutic regimen in response to blood glucose values and to help individuals adjust their dietaryintake, physical activity, and understanding insulin doses to improve glycemic control on a day-to-day basis.

Thus, SMBG can aid in diabetes control by:

Facilitating the development of an individualized blood glucose profile, which can thenguide health care professionals in treatment planning for an individualized diabeticregimen

Giving people with diabetes and their families the understanding of day-to-daytreatment choices in diet and physical activity as well as in insulin or other agents.

Improving patients' recognition of hypoglycemia or severe hyperglycemia; and Enhancing patient education and patient empowerment regarding the effects of

lifestyle and pharmaceutical intervention on glycemic control.1

Take Home Message 1

SMBG has been recommended for people with diabetes to achieve a target level of glycemiccontrol and thus achieve their HbA1c target.

Take Home Message 2

Appropriate use of SMBG data can help to improve glycemic control, select an anti-diabeticregimen, and provide powerful feedback to patients wishing to blood glucose control.

Take Home Message 3

More frequent self-monitoring of blood glucose levels was associated with clinically better glucose

control regardless of diabetes type or therapy.2

When to test blood glucose

Timing your routine testing as recommended by healthcare professional can help one see how yourmeals, medications and activities affect your blood sugar. The American Diabetes Association

(ADA) recommends that you routinely test blood sugar as an effective part of any self-careprogram. For people using insulin, the ADA recommends testing 3 or more times a day. If you takeanother kind of medication, test your blood sugar level as often as your healthcare teamrecommends. Your logbook is a good way to keep track of routine testing results.

You and your healthcare team will determine how often you should test your blood sugar based onyour current health, age and level of activity, as well as the time of day and other factors. Theymay suggest that you test your blood sugar at any of the following times:

http://www.joslin.org/info/monitoring_your_blood_glucose.htmlhttp://www.joslin.org/info/monitoring_your_blood_glucose.htmlhttp://www.joslin.org/info/monitoring_your_blood_glucose.htmlhttp://www.joslin.org/info/monitoring_your_blood_glucose.html

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Before each meal 1 or 2 hours after a meal Before a bedtime snack In the middle of the night Before physical activity, to see if you need a snack During and after physical activity

Set small goals you can act on

In addition to your routine testing schedule, you may want to check your blood sugar, which mayalso be suggested by your healthcare professional, if you:

Think your blood sugar is too high or too low Adjust your insulin or oral medication

Begin a new medication unrelated to diabetes Change your activity program, meal plan, work or school schedule Are sick or under stress

How to test blood glucose

To check your blood glucose level, collect your blood glucose meter, a test strip and lancingdevice. You'll want to:

Wash and dry your hands using warm water may help the blood flow. Turn on the meter and prepare a test strip as outlined in your owner's booklet. Choose your spot-don't check from the same finger all the time. Follow the manufacturer's instructions to prepare the lancing device and get a drop of

blood from the side of your fingertip or other approved site.

Check your blood sugar by touching and holding the test strip opening to the drop untilit has absorbed enough blood to begin the test.

View your test result and take the proper steps if your blood sugar is too high or low,based on your doctor's recommendations.

Discard the used lancet properly. Record the results in a logbook, hold them in the meter's memory or download to a

computer so you can review and analyze them later.

Using your blood glucose test results

Routine blood glucose testing is an essential practice in daily self-care. It also helps one to seehow body handles blood sugar. When you look at the patterns in your numbers, you can see howdifferent kinds of food, activity and stress affect the blood sugar. This can help:

Provide helpful information to healthcare team. Fine-tune meals, medication or activities.

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Improve blood sugar and keep it within a healthy range. Feel better and have more energy. Reduce your risk of long-term complications.

Most people with blood sugar levels in target range actually feel better. You can check the notes inyour logbook to see how you felt when you were in your target range, and when you were out of

range. These blood glucose testing numbers are clues to connect how the things you do affectyour blood sugar.

Do highs or lows affect how I feel?

It's not unusual for your blood glucose test results to be out of range now and then. But if you seea pattern of highs or lows outside your target range, you may want to ask yourself:

Did I change my meal plan or eat any unusual food? Did I change my physical activity? Did I forget to take my medication, take it at the wrong time, take too little or too

much?

Am I taking a new medication? Am I stressed about something? Do I have an infection or an illness? Did I drink alcohol?

It's important to talk with your healthcare team when your blood sugar is:

Extremely high or low High more than once in 24 hours Low more than once in 24 hours High or low at the same time on several consecutive days

Knowing your blood glucose numbers puts you in control of your diabetes care.