Self-monitoring of blood glucose to achieve a good HbA1c
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Self-monitoring of blood glucose to
achieve a good HbA1cRichard Croft
Diabetes Lead Berkshire West
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The impact of a 1% reduction in HbA1c
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Correlation with complications
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HbA
1c (D
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No. Pots of strips used
Scatter graph to show correlation of HbA1c and number glucometer strips used
HbA1c DCCT (TR 6.5 - 7.5%)
Audit of correlation between number of pots of strips used and HbA1c amongst diabetics at Tilehurst
((There is no correlation at all!)
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Think: why is he testing?What will he do with the result?
What will YOU do with the result?
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Diabetics who use insulin – Type 1, and Type 2 who use insulin
Women with gestational diabetes Some patients who use sulphonylureas
(eg gliclazide), especially if they drive Other patients with intercurrent illness
Who should use them?
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Everybody else!!
And who should not use them (usually)?
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• To detect hypo- and hyper-glycaemia in diabetics who use insulin (and SUs)
• To help patients prevent immediate serious illness (hypoglycaemic attacks and DKA)
• As part of the long-term management of diabetes to maintain good control and prevent micro- and macro-vascular complications
Why test at all?
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In Type 1 DM◦ Before meals 4-7mmol/l◦ 2hrs after meals < 9mmol/l
In Type 2 DM◦ Before meals 4-7mmol/l◦ 2 hrs after meals < 8.5mmol/l
Targets for SMBG
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• Twice daily insulin therapy– Test 2-3x day, varying testing times between
fasting, premeal and postmeal to identify trends
• Intensive insulin therapy (basal bolus)– Monitor 2-4x day normally– Monitor at least 4x day if they alter doses at
mealtimes• More frequent testing during
intercurrent illness
Monitoring in Type 1 DM
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• Twice daily insulin regime– Test 1-2x day varying times between fasting,
premeal and postmeal• Intensive insulin therapy (basal bolus)
– Monitor 2-4x day normally– Monitor at least 4x day if they alter doses at
mealtimes• Once daily insulin (basal regime)
– Test fasting BG once daily during initiation, can then be reduced to 1-2x week)
Monitoring in Type 2 diabetics who use insulin
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Naseem is going to talk some more about testing in Type 1 diabetes
We are going to introduce carbohydrate counting as a means of improving control in people with Type 1, and a very smart device to help patients calculate their correct dose of insulin
How can we do better?